Xanthogranulonatous pyelonephritis: report of 5 cases / 北京大学学报(医学版)

Xanthogranulomatous pyelonephritis (XGP) is an unusual form of chronic pyelonephritis in which the renal parenchyma is destroyed and replaced by lipid-laden foamy macrophages. It usually affects middle-aged women with a history of recurrent urinary tract infection, diabetes, or kidney stones. The inflammatory process is usually diffuse and can extend beyond the kidney. The rare focal forms may simulate primary renal tumours. The preoperative imaging diagnosis may be difficult. We reported five cases of XGP, The findings of ours were recorded including kidney size, shape, contour, the echogenecity of the renal parenchyma, the internal echoes of the dilate collecting system, the presence of perinephric fluid accumulation and obstruction. One of the 5 cases was a male patient, and the other four were female, with a mean age of 53 years. He affected kidneys of the 5 cases swelled in different degrees, and one of them was found with line-like anechoic fluid. Among the 5 cases, one kidney appeared as diffusely reducing of the parenchyma echogenicity, multiple hypoechoic areas, disappearance of corticomedullary differentiation and multiple hyperecho with shadow. A round cystic anechoic lesion was found in one kidney, with internal punctate echo and peripheral fluid. Ultrasonographic finding of 1 case was extremely hypoechoic lesion on the left kidney, protruding from the outline of the kidney, with the partial renal capsule discontinuous, the less clear boundary, and a little blood flow in it. Ultrasonographic demonstration of 2 cases was mild dilatation of the collecting system with irregular wall thickening and internal hypoechogenicity, and 1 case was solid lesion with less clear boundary to the pelvic wall and a small amount of blood flow signal, the another 1 case was showed floccule without internal blood flow. Three cases were caused by chronic obstruction verified by operation, of which one was staghorn calculi, one was poorly differentiated squamous cell carcinoma in the middle part of the ureter, and one was inflammatory stricture of upper ureteral. Through analysis of the above five cases and review of related literature, we explored diagnoses and management of the patients with XGP. Xanthogranulomatous pyelonephritis (XGP) is a rare chronic variant of pyelonephritis characterized by destruction of the renal parenchyma. Combining ultrasonographic features of XGP with clinical recurrent urinary infection and chronic obstruction, XGP can be included in the differentiation. The diagnosis of XGP suspected by ultrasound can be clarified by CT, MRI, contrast-enhanced ultrasound.

Evaluation of the Morphology and Function of Medial Collateral Ligament afterTotal Knee Arthroplasty with High-frequency Ultrasound / 中国医学科学院学报

Objective To explore the feasibility and clinical value of ultrasonography in evaluating the morphology and function of medial collateral ligaments (MCL) after total knee arthroplasty (TKA). Methods Totally 38 patients undergoing routine KTA (group A) and 22 patients undergoing constrained condylar knee arthroplasty KTA with MCL injury (group B) were included. Long axis views of MCL were taken and the MCL thickness was measured on femur side and tibial side 1 cm away from the joint line, respectively. The thicknesses were compared between the two groups. Subsequently, the gap between the metal part of the femoral prosthesis and the spacer after dynamic valgus stress was measured. The distribution and composition of the gap between the two groups were compared. Results High-frequency ultrasound clearly showed the prosthesis and MCL after TKA. MCL fiber structures of both groups were intact. The MCL thickness on the tibial side in group B was (0.25±0.06)cm, which was significantly thinner than group A [(0.32±0.14)cm] (t=2.12, P=0.040).For the femur side, there was no significant difference (t=1.65, P=0.110) between these two groups [(0.37±0.09) cm in group B versus (0.42±0.12)cm in group A]. Under the condition of valgus stress, the gaps between the metal part of the femoral prosthesis and the spacer could be found in 11 cases in group B but only in 1 case in group A. The proportion of gaps in group B was significantly higher than that in group A (Fisher's exact test, P=0.000). Conclusions High-frequency ultrasound can clearly show the prosthesis and MCL after TKA. The injured MCL can be well joined but the thickness is thinner. Under the condition of valgus stress of the knee, the stability of the TKA can be evaluated according to the gap between the prosthesis and the spacer.

Sonographic features of focal Hashimoto's thyroiditis / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the diagnostic values of gray-scale and color Doppler ultrasound in the diagnosis of focal Hashimoto's thyroiditis (FHT).</p><p><b>METHODS</b>The gray-scale and colour Doppler ultrasound data of 120 patients with histopathologically confirmed FHT were retrospectively studied. The background of thyroid parenchyma was subjectively evaluated as absence or presence of diffuse Hashimoto's thyroiditis. The vascular types of thyroid nodules were determined as follows: hypovascularity, marked internal flow, marked peripheral flow, and focal thyroid inferno.</p><p><b>RESULTS</b>Among all 120 nodules, 71 (59.2%) were located in normal thyroid parenchyma, 49 (40.8%) in the background of diffuse Hashimoto's thyroiditis. In the normal thyroid background, hypoechoic nodules accounted for 85.9% (61/71), and only 14.1% (10/71)nodules were isoechoic or hyperechoic. However, in the background of diffuse Hashimoto's thyroiditis, 40.8% were hypoechoic and 59.2% were isoechoic or hyperechoic. The difference was statistically significant (P<0.001). In terms of the vascular types, the hypovascularity, marked internal flow, marked peripheral flow, and focal thyroid inferno accounted for 45 %, 25.9%, 20.8%, and 8.3%, respectively.</p><p><b>CONCLUSION</b>The "focal inferno" is a relative specific color Doppler feature of FHT.</p>

Self-made ultrasound/fluorescent bi-functional contrast agent for rabbit's normal lymph node imaging / 中国医学科学院学报

<p><b>OBJECTIVE</b>To prepare a lymph node-targeted ultrasound/fluorescence bi-functional imaging contrast agents, and observe its effectiveness both on contrast-enhanced ultrasound (CEUS) and vivo near infrared fluorescence (NIR) imaging through animal experiments.</p><p><b>METHODS</b>The chimeric lymph node-targeted ligand (phosphatidylserine) and near-infrared fluorescent substance were assembled to form bi-functional contrast microbubbles. The morphology and size distribution were detected by optical microscope and Malvern potential tests. Five normal New Zealand white rabbits were subcutaneously injected with the prepared contrast agent in bilateral footpads, and the imaging effectiveness of lymph nodes and lymphatic vessel were observed by CEUS and NIR technique. Then blue dye was subcutaneously injected at the same site, and the rabbits were sacrificed for lymph nodes pathological examination.</p><p><b>RESULTS</b>Lipid ultrasound microbubbles,with a mean size of 3-5 Μm in diameter, appeared to be uniform in distribution and regular in configuration. The images of inflow lymphatic vessel and relevant lymph node were quickly showed up after the subcutaneous injection by CEUS, which was identical to the result detected by NIR. Biopsy confirmed that all the blue-stained lymph nodes could be displayed by NIR.</p><p><b>CONCLUSIONS</b>The self-made bi-functional contrast agent has a good imaging ability in CEUS and NIR imaging. It may be a better agent as lymph node tracer.</p>

Application of intraoperative spinal ultrasonography in thoracic spinal decompressive operations / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the feasibility and clinical value of intraoperative ultrasonography (IOUS) in thoracic spinal decompression surgery.</p><p><b>METHODS</b>Ten patients with confirmed thoracic spinal stenosis underwent thoracic spinal decompression in our center from August 2009 to December 2010. The appearance of the compressed section of spinal cord was observed with IOUS. Before and after the decompression operation, the diameters of dural sac and the spinal cord were recorded respectively. The location and nature of the compression-causing mass were confirmed.</p><p><b>RESULTS</b>IOUS clearly showed the shape of the normal and the compressed sections of dural sac and spinal cord. In the 14 thoracic spinal cord sections of these 10 patients, the anteroposterior diameter, horizontal diameter, and their ratio were bigger than those before decompression. The values of anteroposterior diameter and anteroposterior/horizontal diameter ratio showed significant differences(the P value of dural sac anteroposterior diameter comparison was 0.008, which of spinal cord was 0.007; the P values of these two structures ratio comparison were both 0.002 before and after decompression), while the horizontal diameter presented no significant differences (the P values of both structures were 0.270 and 0.195 respectively before and after decompression).</p><p><b>CONCLUSIONS</b>IOUS can clearly show the morphological changes of the dural sac and spinal cord before and after the decompression. In addition, it helps surgeons to locate and specify the nature of the compression-causing mass on the ventral side of dural sac. Furthermore, IOUS can suggest whether the decompression is sufficient in a real-time manner.</p>

Left ventricular flow vector characteristics and the relationship between flow vector and left ventricular systolic function in patients with anterior myocardial infarction / 中华心血管病杂志

<p><b>OBJECTIVE</b>To assess left ventricular vortex and flow vector features and the relationship between vector flow and left ventricular systolic function in patients with anterior myocardial infarction by echocardiography-derived vector flow mapping (VFM).</p><p><b>METHODS</b>Echocardiography was performed in 31 patients with anterior myocardial infarction and 20 healthy controls. Flow vector and velocity of left ventricle were analyzed on apical 3 chambers view with color Doppler.</p><p><b>RESULTS</b>(1) Left ventricular intracavitary vortex during isovolumic contraction phase could be detected in both groups. Vortex was detectable also during contraction phase and relaxation phase in patients with myocardial infarction. There was no vortex during contraction phase, and there was only small and transit vortex during relaxation phase in control group. (2)Flow vector of apex and middle segments directed to apex and was opposite to that of basal segment of left ventricle in patients with myocardial infarction and in controls [(10.6 ± 8.3) cm/s vs. -(5.8 ± 7.2) cm/s, (19.5 ± 11.8) cm/s vs. -(16.6 ± 14.7) cm/s]. During rapid relaxation phase, the velocity in apex was lower in patients with myocardial infarction than that in control group [(6.8 ± 9.8) cm/s vs. (17.6 ± 15.8) cm/s, P < 0.01]. (3) There was a negative correlation between velocity in apex and left ventricular ejection fraction (LVEF) during rapid eject phase in patients with anterior myocardial infarction (r = -0.52, P < 0.05). Velocity in apex of patients with LVEF < 50% was higher than that of patients with LVEF ≥ 50% during rapid eject phase [(13.5 ± 9.0) cm/s vs. (5.8 ± 5.1) cm/s, P < 0.05].</p><p><b>CONCLUSIONS</b>Vortex period is prolonged in patients with anterior myocardial infarction compared to normal controls during whole cardiac cycle, flow vector of apex and middle segments is directed to apex during eject phase and there is a negative correlation between velocity in apex and LVEF during rapid eject phase in patients with anterior myocardial infarction.</p>

Exploration of standardized vascular ultrasound training in China / 中华医学超声杂志（电子版）

Objective To explore standardized continuing vascular ultrasound training in China.Methods Data of current ultrasound practitioner education levels in the secondary and tertiary hospitals were collected.Under the direction of the Chinese Ultrasound Doctor Association (CUDA),Vascular Ultrasound Guidelines were introduced.The CUDA Steering Committee for Standardized Vascular Ultrasound Training and Vascular Ultrasound Training Centers were established.Results The questionnaires were received from 182 ultrasound departments of 57 secondary hospitals and 125 tertiary hospitals.The proportion of ultrasound practitioners who obtained a university degree was significantly higher in the ultrasound departments of tertiary hospitals than that in the secondary hospitals (75.18% vs 52.63%).The proportion of ultrasound practitioners who only received short-term ultrasound training and did not have tertiary education was significantly higher in the ultrasound departments of secondary hospitals than that in the tertiary hospitals (8.31% vs 1.03%).The directors of ultrasound departments in both secondary and tertiary hospitals believed that ultrasound practitioners should at least have a university diploma and preferably have a university degree.The CUDA and the American Registry for Diagnostic Medical Sonography (ARDMS) co-hosted two standardized vascular ultrasound training seminars and the first Registered Physician in Vascular Interpretation (RPVI) credential examination in Beijing.A well-known vascular ultrasound reference book,Introduction to Vascular Ultrasound was translated from English into Chinese and published in September 2008.The CUDA Vascular Ultrasound Guidelines were drafted by 12 vascular ultrasound experts from China,U.S.and Australia,which were widely discussed and passed by the CUDA Standing Committee.The guidelines have been published in the Chinese Journal of Ultrasonography and on the website of CUDA (www.cuda.org.cn).The CUDA has signed a publishing contract with a medical press to publish the guideline booklet.The CUDA Steering Committee for the Standardized Vascular Ultrasound Training was established which includes 24 domestic and foreign experts.The CUDA Standardized Vascular Ultrasound Training Centers were awarded to 12 hospitals,which were selected,trained and assessed by the CUDA from 35 candidates.Each center is expected to undertake one to two standardized vascular ultrasound training courses each year.Conclusion Continuing education of vascular ultrasound introduced by CUDA has been accepted positively by a portion of Chinese doctors with ultrasound major.

Application value of contrast-enhanced ultrasonography in the diagnosis of biliary diseases / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the usefulness of contrast-enhanced ultrasonography (CEUS) in the diagnosis of biliary diseases.</p><p><b>METHODS</b>CEUS was performed in 57 patients with biliary diseases. The contrast enhancement characteristics and the morphologic features were observed. The ultrasonographic results were compared with those obtained through conventional 2-D ultrasound (2D-US), color Doppler flow ultrasound (CDFI), and clinical, surgical, and laboratory findings. In some cases, the ultrasonographic results were also compared with those obtained from contrast-enhanced computed tomography (CECT).</p><p><b>RESULTS</b>The diagnostic accuracy of 2D-US combined with CEUS was significantly higher than that of 2D-US combined with CDFI 87.7% vs 71.9%; chi(2) = 4.41, P < 0.05). CEUS clearly showed the presence/absence of blood supply in biliary lesions and offered real-time imaging of the microcirculation perfusion in the lesions. It also offered useful information to differentiate biliary tumors from stones, bile mud, and/or blood clots. It distinctly displayed the size and contour of the lesions as well as the infiltrated range, depth, and the involved area. However, CEUS is most useful in reflecting blood perfusion patterns; it had limited value in differentiating the malignancies of polypoid lesions. The diagnostic accuracy (87.0% vs 91.3%;chi(2) = 0. 45, P > 0.05) and the size and range of the lesions displayed (0.4-6.2 cm vs 0.4-6.0 cm, P = 0.721) were not significantly different between CEUS and CECT.</p><p><b>CONCLUSION</b>CEUS is a useful tool in the routine ultrasonography of biliary diseases.</p>

Ultrasound elastography of ethanol-induced hepatic lesions: in vitro study / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To study the value of ultrasound elastography in evaluation of ethanol-induced lesions of liver.</p><p><b>METHODS</b>Alcohol with a dose of 2 ml was injected into a fresh porcine liver under ultrasound guidance to create stiff necrosis. Then freehand elastography of the lesion from the identical scan plane was obtained with SONOLINE Antares system using VF10-5 probe at about every 30 seconds till 6 minutes later. The original high quality radiofrequency data were acquired through an ultrasound research interface which was provided by the ultrasound system. Then, corresponding elastograms were produced offline using cross-correlation technique and compared with gross pathology findings.</p><p><b>RESULTS</b>Gray-scale sonogram showed a hyperechoic area with acoustic shadow below appeared immediately after alcohol injection. The hyperechoic area tended to be diffuse and its boundary to be illegible with time. On the contrary, the ethanol-induced lesion in elastogram appeared as a low strain hard region surrounded by high strain soft hepatic tissues, with clear but irregular boundaries. Sequential elastograms with the sketched lesion boundaries showed that the lesion area increased in the first 3 minutes after ethanol injection, and then reached a plateau which corresponding to gross specimen.</p><p><b>CONCLUSION</b>Ultrasound elastography is capable of detecting and evaluating the diffusion of ethanol-induced hepatic lesion, and more sensitive and accurate than routine sonography.</p>

Ultrasound elastography of ethanol-induced hepatic lesions / 中国医学科学院学报

<p><b>OBJECTIVE</b>To study the value of ultrasound elastography in the evaluation of ethanol-induced lesions of liver.</p><p><b>METHODS</b>Alcohol with a dose of 2 ml was injected into a fresh porcine liver under ultrasound guidance to create stiff necrosis. Then freehand elastography of the lesion from the identical scan plane was obtained with Siemens SONOLINE Antares system using VF10-5 probe at about every 30 seconds till 6 minutes later. The original high-quality radio-frequency data were acquired through an ultrasound research interface provided by the ultrasound system. Corresponding elastograms were then produced offline using cross-corre-lation technique and compared with gross specimen.</p><p><b>RESULTS</b>A hyperechoic area with acoustic shadow below appeared immediately after alcohol injection. The hyperechoic area diffused and its boundary was illegible following injection. On the contrary, the ethanol-induced lesion in elastography appeared as a low strain hard region surrounded by high-strain soft hepatic tissues with clear but irregular boundaries. Sequential elastograms with the lesion boundaries sketched showed that the lesion area grew in the first 3 minutes after ethanol injection and then reached a plateau, which corresponded to the gross specimen.</p><p><b>CONCLUSION</b>Ultrasound elastography can be used to detect and evaluate the diffusion of ethanol-induced hepatic lesion.</p>

Preparation of polyelectrolyte multilayer coated microbubbles for use as ultrasound contrast agent / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To prepare and characterize polyelectrolyte multilayer film coated microbubbles for use as ultrasound contrast agent (UCA) and evaluate its effects in ultrasonic imaging on normal rabbit's liver parenchyma.</p><p><b>METHODS</b>Perfluorocarbon (PFC)-containing microbubbles (ST68-PFC) were prepared by sonication based on surfactant (Span 60 and Tween 80). Subsequently, the resulting ST68-PFC microbubbles were coated using oppositely charged polyelectrolytes by microbubble-templated layer-by-layer self-assembly technique via electrostatic interaction. The enhancement effects in ultrasonic imaging on normal rabbit's liver parenchyma were assessed.</p><p><b>RESULTS</b>The obtained microbubbles exhibited a narrow size distribution. The polyelectrolytes were successfully assembled onto the surface of ST68-PFC microbubbles. In vivo experiment showed that polyelectrolyte multilayer film coated UCA effectively enhanced the imaging of rabbit's liver parenchyma.</p><p><b>CONCLUSIONS</b>The novel microbubbles UCA coated with polyelectrolyte multilayer, when enabled more function, has no obvious difference in enhancement effects compared with the pre-modified microbubbles. The polymers with chemically active groups (such as amino group and carboxyl group) can be used as the outermost layer for attachment of targeting ligands onto microbubbles, allowing selective targeting of the microbubbles to combine with desired sites.</p>

Preparation of polyelectrolyte multilayer film-coated microbubble ultrasound contrast agent / 中国医学科学院学报

<p><b>OBJECTIVE</b>To prepare polyelectrolyte multilayer film-coated microbubble ultrasound contrast agent (UCA) and evaluate its effects in contrast imaging on normal rabbit's liver parenchyma.</p><p><b>METHODS</b>Perfluorocarbon (PFC) -containing microbubble UCA (ST68-PFC) were prepared by sonication-based on surfactants (Span 60 and Tween 80). Subsequently, the resulting ST68-PFC microbubbles were coated using oppositely charged polylysine (PLL) and alginate (Alg) by microbubble-templated layer-by-layer self-assembly technique via electrostatic interaction. The enhancement effects in contrast imaging on normal rabbit's liver parenchyma were assessed.</p><p><b>RESULTS</b>The obtained microbubble UCA exhibited a narrow size distribution. The polyelectrolytes were successfully assembled onto the surface of ST68-PFC microbubbles. In vivo experiment showed that polyelectrolyte multilayer film-coated UCA effectively enhanced the imaging of rabbit's liver parenchyma.</p><p><b>CONCLUSIONS</b>The novel microbubble UCA obtained via layer-by-layer self-assembly, when enabling more functions, has no obvious difference in enhancement effects compared with the premodified microbubbles. The polymers with chemically active groups (such as amino group and carboxyl group) can be used as the outermost layer for the attachment of targeting ligands to microbubbles, which allows the selective targeting of the microbubbles to desired sites.</p>

Application of contrast-enhanced ultrasound in the diagnosis of renal cystic lesion / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the value of contrast-enhanced ultrasound (CEUS) in the diagnosis of renal cystic lesion.</p><p><b>METHODS</b>Totally 88 patients with 97 atypical cystic lesions of kidneys were examined by conventional ultrasound (color Doppler flow imaging and power Doppler flow imaging), CEUS, and contrast-enhanced computed tomography (CECT), respectively. The results from the three imaging approaches were classified by Bosniak classification system and compared with each other. In patients who underwent surgeries, the pathological results were used to validate the imaging results.</p><p><b>RESULTS</b>The results of CEUS and CECT on atypical cystic lesions were not significantly different (P > 0.05). The results gained by conventional ultrasound were significantly different from those of CEUS and CECT (P < 0.05). Compared with the pathological results of 32 patients who underwent surgery, the sensitivities of CEUS in the diagnosis of benign, doubtfully malignant, and malignant cystic tumors of kidney were 63.2%, 95.0%, and 94.7%, respectively, the specificities were 92.9%, 76.9%, and 85.7%, respectively, and the accuracies were 75.8%, 87.9%, and 90.0%, respectively.</p><p><b>CONCLUSIONS</b>The classification of atypical cystic lesions using CEUS is highly consistent with CECT. CEUS is valuable in the diagnosis of benign and malignant renal cystic lesions.</p>