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Objective@#To analyze the image features of shear wave elastrography (SWE) in breast masses, and to evaluate their values in the differentiation of benign and malignant breast lesions.@*Methods@#A total of 361 patients with 403 breast lesions who simultaneously underwent conventional ultrasound and SWE examination from February 2015 to January 2018 were selected. Diagnosis in all patients was confirmed by aspiration biopsy or operative pathology. The SWE images were collected and the elastic images were divided into 5 types. The SWE image features of different breast pathological types were summarized, and their values in benign and malignant breast lesion diagnoses were evaluated.@*Results@#The main features of benign breast lesion were type Ⅰ and Ⅱ, the main features of the malignant lesion were type Ⅳ and Ⅴ, and the proportion of which were 43.6% (71/163), 37.4% (61/163), 22.1% (53/240) and 57.9% (139/240), respectively. Type Ⅲ accounted for a certain proportion in both benign and malignant lesions. The SWE image features of benign and malignant lesions were compared and a significant difference was observed (P<0.001). The type Ⅴ features were mainly observed in invasive ductal carcinoma, invasive lobular carcinoma and other types of invasive carcinoma, while the type Ⅳ features were mostly presented in ductal carcinoma in situ and mucinous carcinoma. Fibroadenoma, fibroadenosis accompanied with fibroadenoma, and fibroadenosis were featured with type Ⅰ. Both intraductal papilloma and benign phyllodes tumor were mostly type Ⅱ, while type Ⅲ and Ⅴ were more common in chronic granulomatous mastitis. When type Ⅰ and typeⅡof breast lesions were classified as benign features while type Ⅳ and Ⅴ were malignant features, the sensitivity and specificity of breast malignant lesion diagnosis were 91.2% and 84.7% by application of SWE combined with breast imaging reporting and data system (BI-RADS). The sensitivity of combined diagnosis was slightly lower than that of conventional ultrasound (P>0.05), but the specificity was significantly higher than conventional ultrasound (P<0.01).@*Conclusion@#The SWE is a simple and effective method. Combination of SWE with conventional ultrasound may improve the diagnostic differentiation of benign and malignant breast lesions.
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Objective@#To investigate the value of shear wave elastography (SWE) in the early diagnosis of hepatic cirrhosis nephropathy.@*Methods@#Seventy-three hepatic cirrhosis patients with normal conventional renal function were enrolled in the study, and were subdivided into Child-Pugh A group, Child-Pugh B group and Child-Pugh C group. Forty healthy volunteers were served as the control group. All the subjects underwent SWE to obtain the Young′s modulus value of left renal cortex, medulla and parenchyma which included Emax, Emin, Emean. The Young′s modulus value were compared among different groups.@*Results@#Compared to the control group, the Emax, Emean of left renal cortex, modulus and parenchyma in hepatic cirrhosis group were higher(P<0.05). Compared to the control group, there was no significant difference in Emax, Emin and Emean of left renal cortex, medulla and parenchyma in group A(P>0.05). The Emax and Emean of left renal cortex, medulla and parenchyma were higher both in group B and group C than those in control group(P<0.05). Comparison of liver cirrhosis among groups, the Emax and Emean of left renal cortex, medulla and parenchyma in group B and group C were higher than those of group A(P<0.05), there was no significant difference between group B and group C(P>0.05).@*Conclusions@#SWE can quantitatively determine the elastic parameters of renal tissue in patients with different degrees of cirrhosis, the change of renal tissue elasticity is earlier than that of routine laboratory examination, SWE can early detect renal tissue damage in patients with liver cirrhosis.
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Objective To analyze the accuracy,repeatability and feasibility of Ultrafast Doppler for renal artery ultrasonography.Methods One hundred and one cases were selected that were suspected to have renal artery disease and were successful of conventional and Ultrafast Doppler for renal artery ultrasonography,and 101 cases were grouped by age (≤40 years old,41-60 years old,≥61 years old),body mass index (BMI) (normal 18.5-23.9 kg/m2,overweight 24.0-27.9 kg/m2,obesity ≥28.0kg/m2) and whether there were the presence of renal artery stenosis (no significant renal artery stenosis and renal artery stenosis ＞60％).Each case was respectively examined by conventional and Ultrafast Doppler for renal artery ultrasonography in a random order.The consistency of Doppler parameters was tested.The duration of each Doppler study was compared and the feasibility of Ultrafast Doppler for renal artery ultrasonography was explored.The Doppler parameters included:renal artery peak systolic velocity (PSV),resistance index (RI),renal segmental artery acceleration time (T) and time consuming (△T).The concordence and △T of two Doppler method were compared.Results ① Ultrafast Doppler had good reproducibility,intraclass correlation coefficient (ICC) values were ＞ 0.6.② For renal artery ultrasonography,the successful number of cases examined by Ultrafast Doppler were more than those examined by conventional Doppler,but the difference was not statistically significant (P ＞0.05).③The Doppler parameters from all subjects and different groups showed a strong positive correlation between the two Doppler studies (P ＜0.05).④ UltraFast Doppler required a shorter time than conventional Doppler (P ＜0.05).⑤The △T of cases with different ages and with or without renal artery stenosis showed no statistically significant (P ＞0.05),however,their △T were increased with body mass index increasing (P＜0.05).Conclusions Ultrafast Doppler for renal artery ultrasonography has a high success rate,a good repeatability and consistency,and a shorter time consuming and simple operation than conventional Doppler.
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Objective To investigate the value of color Doppler flow imaging(CDFI) in diagnosing lower limb artery in-stent restenosis (ISR), and to provide the evidences for clinical application. Methods Patients with lower limb artery percutaneous transluminal stent insertion in 12 months were enrolled in this study and divided into two groups, CT angiography (CTA) or digital subtraction angiography (DSA) was applied to diagnose ISR, 31 patients with 47 stenting which were diagnosed ISR was named as restenosis group, 63 patients with 89 stenting which were diagnosed no ISR was named as no stenosis group, and 30 normal person was enrolled and named as normal control group. Ultrasonic characteristics and peak systolic blood flow velocity (PSV), systolic blood flow acceleration time (AT) of proximal part, inner stents, distal part were recorded in restenosis group and no stenosis group, then compared with data in normal control group. Regression and receiver operator (ROC) curve were applied to analyse the correlation between PSV and AT. Results PSV of no stenosis group in common femoral artery, femoral artery, superifcial, popliteal artery stent respectively were (146.71±35.59) cm/s, (120.11±25.67) cm/s, (96.44±32.87) cm/s. PSV of normal control group in common femoral artery, femoral artery, superifcial, popliteal artery respective were (119.67±15.34) cm/s, (91.17±15.09) cm/s, (71.13±21.23) cm/s. There was statistically signiifcant difference between the two groups (t=2.457, 2.459, 2.321, all P0.05). PSV of restenosis group in proximal part, restenosis part, distal part respectively were (87.67±23.34) cm/s, (218.17±72.09) cm/s, (54.13±21.23) cm/s. PSV of no stenosis group in proximal part, inner stents, distal part respectively were (91.71±25.59) cm/s, (131.11±45.67) cm/s, (96.44±32.87) cm/s. There was statistically significant difference between restenosis part/inner stents, distal part (t=3.412, 3.511, both P0.05). AT of restenosis group in proximal part, restenosis part, distal part respectively were (98.31±14.09) ms, (109.54±21.03) ms, (158.23±45.21) ms. AT of no stenosis group in proximal part, inner stents, distal part respectively were (84.98±13.77) ms, (86.34±19.36) ms, (83.77±17.05) ms. There was statistically signiifcant difference between restenosis part/inner stents, distal part (t=2.319, 3.610, both P0.05). ROC curve showed that in ISR lower limb artery, PSV>168 cm/s had a sensitivity of 89.4%, speciifcity of 92.1%, the area under the ROC curve was 0.949;AT>127 ms, had a sensitivity of 86.8%, speciifcity of 98.0%, the area under the ROC curve was 0.867. Conclusions CDFI can detect the changes of PSV and AT, ISR can be detected and diagnosed earlier in lower limb artery. By combining PSV>168 cm/s with AT>127 ms, the value of ISR diagnosis can be increased.
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Objective To investigate the alteration of peripheral tissue`s temperature of the coagulation zone of microwave ablation in brain tissue, and to provide experimental evidence for clinical application. Methods Twelve canines were treated by microwave ablation in brain tissue. Each was ablated for 180 s with microwave output power of 20 W, 30 W, and 40 W. During the operation the peripheral temperature at the distance of 0.5 cm, 1.0 cm, 1.5 cm and 2.0 cm from the ablation center was recorded respectively. The ultrasound was performed 1 hour after the operation, and then the animals were executed and the microscopic changes of the ablation lesion were observed. Results Eleven canines suffered well for the ablation, while 1 presented abnormal respiration during the operation and died 2 hours later. During the operation, the temperature of the area 0.5 cm from the center rose signiifcantly, with the maximum temperature was (96.40±1.46)℃at the power of 20 W, and 100℃at the power of 30 W and 40 W. The temperature of the area 1.0 cm from the center rose faster, with the maximum temperatures at different powers all above the 46℃. The temperature of the area 1.5 cm from the center rose slower, with the maximum temperature below 46℃at the power of 20 W and 30 W and above 46℃at the power of 40 W. The maximum temperatures of the area 2.0 cm from the center at different powers were all below 46℃. The difference of the maximum temperature at different distances (1.0 cm, 1.5 cm, and 2.0 cm from the center) was signiifcant (F=776.78, 2640.64 and 3025.53, all P<0.05). The length and width of the ablation lesion as well as the area of edema increased with the power. At the power of 20 W, 30 W, and 40 W, the length of the ablation lesion was (29.3±1.8) mm, (32.7±2.1) mm and (34.2±2.4) mm, the width was (22.5±1.5) mm, (23.7±1.7) mm and (27.1±2.0) mm, and the width of the edema zone was (2.3±0.4) mm, (2.6±0.4) mm and (2.7±0.5) mm. The differences of the length and width of the ablation lesion at different powers were signiifcant (F=11.46, 14.49, both P<0.01). The difference of the edema area at different powers was insigniifcant (F=1.94, P=0.169). Conclusions Microwave ablation is a safe therapeutic modality. However, the shorter distance from the ablation center and greater ablation power give rise to larger ablation lesion, higher maximum temperature, and faster temperature increase. Therefore, 2.0 cm from the ablation center is a safe area.
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Objective To explore the value of contrast-enhanced ultrasound (CEUS) in classifying lesions,measuring the range of lesions,and the ability of manifesting the boundary and the severity of lesions after traumatic brain injury.Methods 83 patients with traumatic brain injury underwent the emergency surgery operations were enrolled in this study.Intraoperative ultrasound was applied in detecting the echo characteristics of lesions and classifying.Traumatic brain injuries which were classified indefinitely by conventional ultrasound were examined by CEUS to observe enhanced features of trauma lesions and the surrounding tissue,confirm the types of lesions,identify the border of lesions,measure the range of lesions,and compare with conventional ultrasound,preoperative CT and operative results.The severity of lesions was judged according to the parameter of time intensity curve (TIC).The results which would help the operators to adjust the method of treatment timely was informed.Results 148 lesions were detected by intraoperative ultrasound among 83 patients in this study.Thirty-two lesions which were classified indefinitely by conventional ultrasound were examined by CEUS.The results of classifying were confirmed by CT and operations,the diagnostic accuracy rate was 100％.The absolute peak intensity was changed with the injury severity,the more serious of the tissue,the lower absolute peak intensity was displayed.The boundary of lesions was manifested clearly after CEUS.Compare to the conventional ultrasonography,the range of lesions was larger.The difference between them was meaningful significally(P =0.01).Based on the results of CEUS,the way of operation was adjusted in 21 lesions.Conclusions Using the contrastenhanced ultrasound and intraoperative ultrasound,various traumatic brain injuries can be diagnosed accurately.By CEUS,the perfusion of lesions would be displayed,which would hint the severity of the brain tissue and help the operators adjust the methods of treatment timely,and provide the reliable evidence for the operation precisely.
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ObjectiveTo explore the value of intraoperative contrast-enhanced ultrasonography in distinguishing gliomas,peritumorous cerebral edema and peripheral normal cerebral tissues,and grading cerebral gliomas.MethodsIntraoperative contrast-enhanced ultrasonic imaging in 80 patients diagnosed cerebral gliomas were studied retrospectively.The blood perfusion patterns of gliomas,peritumorous cerebral edema and peripheral normal cerebral tissues were observed closely after contrast and parameters were recorded.ResultsAfter contrast-enhanced ultrasound,peripheral normal cerebral tissues showed homogeneous enhancement,the tumor tissues and peritumorous cerebral edema of high-grade gliomas (HGG) showed high enhancement,but peritumorous cerebral edema of low-grade gliomas (LGG) showed nearly homogeneous enhancement.Absolute peak intensity(API) of the tumor tissues were higher than those of peripheral normal cerebral tissues and peritumorous cerebral edema ( P ＜0.05).Time to peak (TTP) of the tumor tissues in HGG were shorter than those of peripheral normal cerebral tissues and peritumorous cerebral edema ( P ＜ 0.05).TTP of the tumor tissues in LGG compared with those of peripheral normal cerebral tissues and peritumorous cerebral edema,two groups had no statistical significance ( P ＞ 0.05).ConclusionsIntraoperative contrast-enhanced ultrasonography can reflect the boundary of the brain edema,which is useful to guide surgical resection effectively and helpful to grade cerebral gliomas.