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Objective To summarize the multimodal ultrasonographic characteristics primary thyroid lymphoma (PTLs), and to discuss the diagnosis and differential diagnosis of PTLs. Methods Multimodal ultrasonographic charactericsits of six cases of PTLs were analyzed retrospectively. All of the patients were examined by the conventional two-dimensional ultrasound (2DUS), color Doppler flow imaging (CDFI), contrast-enhanced ultrasound (CEUS), three-dimensional ultrasound (3DUS) reconstruction and elastography imaging (EI) from October 2011 to February 2016 in Changzheng Hospital, affiliated to Secondary Military Medical University. All diagnoses were confirmed by ultrasound-guided percutaneous biopsy.Results (1) 2DUS: six cases of PTLs without capsule were observed as diffusely enlargement type (two cases), unilateral nodular type (one case, on left lobe),and bilateral multiple nodular type (the other three cases). The margin of the multiple nodules were not clear, and some nodules were fused with each other.There were four cases of heterogeneous (extremely) hypoechogenicity and two cases of mixed echogenicity, All of the lesions were characterized by various striped and reticular hyperechogenicity interiorly on ultrasonograms, and only one case showed slightly posterior enhancement. Except one case, multiple cervical lymphnodes hyperplasia were identified on neck regionⅡ-Ⅴin five cases. (2) CDFI and CEUS:CDFI showed abundant blood flow signals in the PTLs nodules peripherally and internally. The striped blood flow was observed in the lesions, and spectrum showed as artery and veins. The plentiful vascular tree was also found in the enlarged lymphnodes. By using high frequency CEUS, six cases of the PTLs demonstrated diffuse and heterogeneous enhancement significantly, including little necrosis area without prominent contrast agent filling in two cases. (3) 3DUS reconstruction: Various striped and reticular hyperechoic features were found on the surface of six cases of PTL nodules. (4) EI: All lesions were soft in six cases. The ratio of elastic strain rate was 1.28-1.96, average (1.82±0.29).Conclusion The ultrasonographic features of PTLs are of certain characteristics, and multiple modes of ultrasound examination can help to grasp the comprehensive imaging informations of PTLs, which should be encouraged positively to facilitate the early detection, early diagnosis and early treatment for PTLs.
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Objective To investigate the ultrasonic and pathological features of porcine striped muscle injury from thermal and chemical factors respectively, and to analyze the limitation of ultrasound diagnosis given by doctors with different skill levels. Methods An experimental study using fresh porcine striped muscle in vitro was designed, where the injury were caused by microwave ablation (2 450 MHz) and Anhydrous acetic acid (99.8%) injection separately. Blind to pathologic results, the two-dimensiona sonograms taken from each model were analyzed by sonographers with different skill levels independently. Finally, the diagnoses were evaluated and compared among them. Results Two-dimensional sonograms showed distinct changes of the textures in both injury models, which was characterized as the disappearance of regular tissue structure. However, the corresponding histopathology revealed obvious differences between the two interventions on ultrasonograms. There was no statistical difference between chief physician and attending doctor (both of them had over 5-year experiences on skeletal muscle ultrasound ) in identifying the ultrasonic features of boundary, shape and muscle texture (Kappa=0.933, 0.845, 0.789;Kappa=0.790, 0.935, 0.865, all P<0.05). Compared with residents′diagnosis, there were signiifcant differences in identifying the ultrasonic features of echo level and muscle texture in both injury models:Echo level in thermal injury group:chief physician vs residents, Kappa=0.323;attending doctor vs residents, Kappa=0.297. Texture feature in thermal injury group:chief physician vs residents, Kappa=0.259;attending doctor vs residents, Kappa=0.112. Texture feature in chemical injury group:chief physician vsresidents, Kappa=0.253;attending doctor vs residents, Kappa=0.070. Conclusions Microwave ablation and Anhydrous acetic acid can cause different histopathologic changes in correspondence with various features on two-dimensional sonograms. But ultrasonographers with different skill levels leads to signiifcant variations in identiifcation and qualitative diagnosis, which is impossible to be quantitatively analyzed. Chief physician and attending doctor can draw a consistent conclusion and demonstrate the ultrasounic characteristics in porcine striped muscle injury model from thermal or chemical factors.
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Objective To make a comparative assessment on both the therapeutic effects and side effects between percutaenous lauromacrogol injection therapy(PLIT) and percutaenous ethanol injection therapy(PEIT) for simple hepatic or renal cyst.Methods In group A,55 patients with simple hepatic or renal cysts underwent ultrasound-guided aspiration and successive PLIT.The intra-operative side effects were investigated and the therapeutic effects assessment by using ultrasonography was conducted 3 months after the treatment.In group B,60 patients with simple hepatic or renal cysts had received ultrasound-guided aspiration and PEIT sometime before.The intra-operative side effects and therapeutic effects on the thirdmonth ultrasonography were independently reviewed according to their case records.Results In group A,3 patients(5.5 ％) expressed slight discomfort but not pain while receiving lauromacrogol injection.Follow-up ultrasound examination at the end of third month demonstrated the cysts in 43 patients completely regressed,while cysts in rest 12 patients shrank over 50 ％ in size,showing the overall response rate(ORR) and completely cure rate(CCR) were 100％ (55/55) and 78.2％ (43/55) for PLIT respectively.In group B,12 patients(20％) suffered from slight to moderate irritating pain or drunk performance.The third-month ultrasound examination disclosed that cysts in 47 patients completely vanished,and cysts in the other 13patients shrank more than a half,indicating the ORR and CCR were 100％ (60/60) and 78.3 ％ (47/60) for PEIT respectively.Conclusions Although their therapeutic efficacy are perfectly similar,PLIT is much more superior to PEIT in term of less and minor side effects.
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Objective To explore the characteristics of changes in temperature and stiffness within the microwave-induced ablation region.Methods A type of Thy-ablation microwave antenna was used upon a design of various combination of ablation duration and power to induce heated region in samples of fresh porcine liver.Three special sites were set to assess the corresponding temperature and stiffness in each heated region.The temperature was continuously measured by using electronic thermometer with microwave on going,while stiffness was determined 5min after the ending of ablation by using real-time ultrasonic elastography,strain ratio,a quantitative indicator.Results The SR values and temperature determinations decreased progressively from the central to the peripheral area of the heated region.There was a linear regression between the temperatures (X) and SRs (Y),with Y =0.666 X-37.17.A significant correlation exists between X and Y,with the correlation coefficient being 0.956(P ＜0.001).The stiffness and temperature at the central sites are variable with the changes of both ablation time and power,but little changed at the peripheral sites of heated-region,which we name a phenomenon due to the ending effect of microwave propagation.Conclusions Temperature and stiffness increase considerably following microwave radiation but they are heterogeneously distributed within the ablated region in porcine liver.The characteristic gradient changes are confirmed of both temperature and the elasticity.It is presumable that good recognition and understanding and full utilization of these characteristics are conducive to reasonable control of tumor microwave ablation therapy.
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Objective To investigate the elasticity reduction of liver tissue due to microwave ablation and the relevance to the histographic damages. Methods An experimental study using fresh porcine liver was designed. Elasto-ultrasonography scanning both in color display and strain ratio calculations was conducted before and 5 min after microwave ablation ( 2450 MHz) in manner of antenna insertion under ultrasound guidance to determine the alterations of the liver elasticity, in correspondence with the histopathologic assessment of each ROI. Results Elasto-ultrasonography showed a significant elasticity reduction and hardness augment of the targeted liver tissue and the corresponding histopathology revealed increases in the amount of massive coagulative necrosis and coking of liver cells after microwave irradiation,in proportional to the applied field power and working time. Conclusions Elasto-ultrasonography helps to demonstrate microwave-induced lesion in porcine liver got rapidly hardened. It is possible to estimate the tissue necrosis to the changing of tissue hardening.