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@#【Objective】To study retrospectively the serum hepatitis B surface antigen（HBsAg）and HBsAg normal⁃ ized to the same hepatic parenchyma cell volume（HPCV），namely，the same hepatic cell quantities，between HBeAg- positive and HBeAg-negative chronic hepatitis B（CHB）.【Methods】A total of 168 CHB patients who had undergone liv⁃ er biopsy and test of serum HBsAg levels due to their disease in the Third Affiliated Hospital of SunYat-sen University were selected as the study subjects. The serum HBsAg levels，as well as HBsAg levels normalized to HPCV（hepatic cell quantities）were compared between HBeAg-positive and HBeAg-negative CHB，respectively.【Results】There was statis⁃ tically significant difference in serum HBsAg levels between HBeAg-positive and HBeAg-negative CHB（P = 0.028）， while there was no statistical difference in HBsAg normalized to HPCV（P = 0.073）. There were no correlations between serum HBsAg and liver inflammation grades（HBeAg-positive：r s = 0.020，P = 0.876 & HBeAg-negative：r s = 0.037，P =0.711）. Similarly，there were no correlations between HBsAg and hepatic fibrosis stages（HBeAg-positive：r s = 0.087， P = 0.488 & HBeAg-negative：r s = 0.144，P = 0.148）. Nevertheless，statistically significant positive correlations were shown between HBsAg normalized to HPCV and liver inflammation grades（HBeAg-positive：r s = 0.309，P = 0.012 & HBeAg-negative：r s = 0.389，P < 0.001）. Similarly，the HBsAg normalized to HPCV and hepatic fibrosis stages were shown to be statistically significantly correlated（HBeAg-positive：r s = 0.490，P < 0.001 & HBeAg-negative：r s = 0.599， P < 0.001）.【Conclusions】Serum HBsAg normalized to HPCV but not HBsAg levels，is correlated with liver inflamma⁃ tion grades as well as hepatic fibrosis stages positively in both HBeAg-positive and HBeAg-negative CHB. But there is no difference in serum HBsAg levels normalized to HPCV between HBeAg-positive and HBeAg-negative CHB.
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@# 【Objective】To study the correlation between hepatocellular jaundice and liver stiffness measurement and reflect the changes in patients with acute-on-chronic liver failure（ACLF）.【Methods】Between January 2015 and March 2016，a total of 150 patients with ACLF-HBV infection were enrolled to collect clinical data，2D-SWE and biochemical variables. According to data distribution，correlation of total bilirubin with LSM by 2D-SWE was assessed by Pearson correlation analysis.【Results】One hundred and twenty-one patients were analyzed and divided into two groups：descended TB group and elevated TB group. For descended TB group，LSM decreased 5.1（2.2～6.6）kPa. For elevated TB group， LSM increased 6.2（1.2～12.8）kPa. A significant parallel correlation between TB and LSM value either the descended TB group or the elevated TB group. For descended TB group，accompanied with the decrease of LSM，patients reached clinical improvement standard and their average hospitalization time was 30 ± 15 days. Six patients underwent liver trans⁃ plantation in the elevated TB group，and showed TB level higher than twenty ULN（the upper limit of normal），ac⁃ companied with increased LSM value. Histological characteristics of these patients showed submassive hepatic necrosis. 【Conclusion】The degree of hepatic necrosis aggravation in patients with ACLF，which results in the continuous increase of TB and LSM，reflects the aggravation of patients′ condition；on the contrary，the decline in value of LSM reflects the improvement of patients′ condition.
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@#【Objective】To explore the feasibility and simplicity of intelligent automatic registration ultrasound-CT/ MR fusion imaging based on liver surface in localization of focal liver lesions. 【Methods】 Thirty patients with detected focal liver lesions by contrast- enhanced CT or MR were enrolled for ultrasound- CT/MR fusion imaging using the PercuNav fusion imaging system in PHILPS EPIQ7. Both intelligent automatic registration ultrasound- CT/MR fusion imaging based on liver surface（intelligent method）and the conventional internal plane method（manual method）were used for ultrasound-CT/MR fusion imaging. The success rate of registration，the initial registration error and the times of fine-tuning were compared between these two methods.【Results】In all 30 patients，the success rates of registration were both 96.67%（29/30）using intelligent method and manual method. There was no significant difference between these two methods when compared the initial registration error and the times of fine- tuning （P>0.05）. According to the further stratified analysis，in 10 lesions in the left liver，the initial registration error of the manual method was less than that of intelligent method，the difference was statistically significant（P=0.00）. Although the times of fine-tuning of the manual method was less than that of intelligent method，there was no statistically significant difference（P=0.09）；In 20 lesions in the right liver，the initial registration error and the times of fine-tuning of the intelligent method were superior to those of the manual method. The differences were statistically significant （P<0.05）. 【Conclusion】 Intelligent automatic registration ultrasound- CT/MR fusion imaging based on liver surface is a feasible method with high success rate for ultrasound-CT/MR fusion imaging. Compared with the conventional internal plane method，the fusion imaging process is more simple and efficient for the lesions in right liver. It helps to reduce experience dependence of fusion imaging for the operators.
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Objective To assess the inlfuence of depth on liver stiffness measurement with real-time shear wave elastography (SWE) and determine the optimal depth for SWE in liver. Methods SWE of liver was performed on 89 healthy volunteers between May 2012 and November 2012. The depths of each liver were varied from 0 cm to 7 cm (from the liver capsule) in 1 cm increment and there were 8 depth groups in total. Then the elastic modulus of liver in each depth group were measured three times by SWE. The body mass index (BMI) and the distance from body surface to liver capsule were documented. The success rates and the mean elastic modulus of each group were calculated. Results The success rates of 0-7 cm were 0, 98.9%(88/89), 98.9%(88/89), 98.9%(88/89), 71.9%(64/89), 24.7%(22/89), 3.4%(3/89) and 0, respectively. The success rates were highest in 1 cm, 2 cm and 3 cm groups but signiifcant decreased with the increasement of depths in 4 cm, 5 cm and 6 cm groups ( 3 cm vs 4 cm, χ2=25.94, P<0.001; 4 cm vs 5 cm, χ2=39.68, P<0.001;5 cm vs 6 cm,χ2=16.79, P<0.001). The mean elastic modulus of 1 cm, 2 cm, 3 cm, 4 cm and 5 cm groups were (4.77±0.99), (4.68±0.99), (4.76±0.95), (5.19±1.10) and (5.41±0.95) kPa, respectively. The mean elastic modulus of 4 cm and 5 cm groups were signiifcant higher than those of 1 cm, 2 cm, 3 cm groups (4 cm vs 1 cm, t=-2.85, P=0.005;4 cm vs 2 cm, t=-3.49, P=0.001;4 cm vs 3 cm, t=-2.76, P=0.006;5 cm vs 1 cm, t=-3.13, P=0.002;5 cm vs 2 cm, t=-3.66, P=0.000;5 cm vs 3 cm, t=-3.05, P=0.003). In the group of 4 cm, the BMI and the distance from body surface to liver capsule of the volunteers performed successfully and unsuccessfully were (20.70±2.87), (22.07±2.42) kg/m2 and (1.45±0.25 ), (1.60±0.29) cm, respectively. In the group of 5 cm, the BMI and the distance from body surface to liver capsule of the volunteers performed successfully and unsuccessfully were (19.82±2.76), (21.49±2.72) kg/m2 and (1.35±0.21), (1.54±0.26) cm respectively. The BMI had no signiifcant difference between the successful and unsuccessful groups (t=-2.83, P=0.108 for 4 cm;t=0.77, P=0.709 for 5 cm), but the distance from body surface to liver capsule was signiifcantly different (t=26.51, P=0.012 for 4 cm;t=79.57, P=0.004 for 5 cm). Conclusions The success rates and elastic modulus were different at different depths. SWE should be performed at the depths of 1-3 cm from the liver capsule.
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Objective To assess the feasibility of three-dimensional contrast-enhanced ultrasonic cholangiography(3D-CEUSC) in cadaver liver.Methods The 3D-CEUSC was performed in 6 cases of cadaver liver.Image quality of 3D-CEUSC was evaluated.The visualization of branching orders,the degree of visibility and coincidence of morphous were compared with those of cholangiagraphy using fluoroscopy.Results The imaging quality of 3D-CEUSC was inferior to that of cholangiography with significant difference.The three-dimensional biliary tree structures were visualized in all 6 3D-CEUSC.The maximum visualization of branching orders in 3D-CEUSC was (3.67±0.52),which was equal to the results(4.00±0.63)by cholangiography (P=0.465).The degrees of visibility of biliary tree were equivalent with those by cholangiography in the first and second order with significant difference.The coincidence of morphous was excellent compared the images of 3D-CEUSC with direct X-ray cholangiography.Conclusion 3D-CEUSC is a new technique as a useful supplement to cholangiography in evaluation of biliary anatomy and variation before graft harvesting in LDLT.
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Objective To assess the value of three-dimensional contrast-enhanced ultrasonography (3D-CEUS) in evaluation of hepatic arteries variants.Methods Both two-dimensional contrast-enhanced ultrasonography (2D-CEUS) and 3D-CEUS were used to assess 30 patients including living donor candidates and patients with upper abdomen tumors.The reference standard was operation or CTA or DSA or MRA,and the accuracy for detecting hepatic artery variants provided by the two methods was evaluated.Arterial anatomic types were defined by using Michels classification.Results The total accuracy for detecting hepatic artery anatomy types by 2D-CEUS was 40.0% (12/30),while 83.3% (25/30) by 2D-CEUS.For convention anatomy types the accuracy on 2D-CEUS and 3D-CEUS were 40.9%(9/22)and 90.9%(20/22),respectively.The difference was statistically significant (P<0.05).For anatomy variants types the accuracy on 2D-CEUS and 3D-CEUS were 37.5%(3/8)and 62.5%(5/8),respectively.No significant difference between these two methods was observed.Conclusion 3D-CEUS was a new method in diagnosis of hepatic arteries anatomy types with practical clinical value in evaluation of the living liver donors.
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Objective To compare the value of conventional ultrasound,hydrosonography and double-contrast enhanced ultrasound in the display capacity of periampullary carcinoma and its relationship with the surrounding tissue.Methods A total of 18 patients with the periampullary carcinoma were diagnosed pathologically or by endoscopic biopsy.Each patient had three imaging modalities by conventional ultrasound,hydrosonography and double-contrast enhanced ultrasound.The display capacity and the relationship between the mass and surrounding tissue were compared with three modalities.Results The display rates of limpid visibilities of carcinoma on conventional ultrasound,hydrosonography and double-contrast enhanced ultrasound were 16.7%(3/18),22.2%(4/18) and 94.4%(17/18),respectively;The display rates of duodenum protrusion on three modalities were 0(0/18),38.9% (7/18) and 72.2% (13/18),respectively,with significant differences among conventional ultrasound,hydrosonography and double-contrast enhanced ultrasound.The double-contrast enhanced ultrasound showed two cases of peripheral vascular invasion and one case of intrahepatic metastasis.Conclusion The double-contrast enhanced ultrasound can increase the display capacity of periampullary carcinoma as a new diagnostic modality for periampullary carcinoma.
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<p><b>BACKGROUND</b>Ultrasound (US) is a popular method in the diagnosis and treatment of uterine leiomyomas, but the lack of accuracy greatly limits its application. Recently, microbubble enhancement technique affords direct depiction of tumor neovascularity and establishes a more precise vascular map of the tumor. This study was undertaken to describe the distribution patterns of SonoVue, a second-generation contrast agent, in the microcirculation of uterine leiomyomas, and to investigate the potential use of contrast-enhanced ultrasound (CEUS) in the characterization and treatment of uterine leiomyomas.</p><p><b>METHODS</b>Ninety-six patients with uterine leiomyomas were enrolled in this study. The CEUS was performed using cadence pulse sequencing technique (CPS) and SonoVue. Enhancement patterns of different lesions were observed. The diagnostic accuracy of CEUS was compared with that of conventional ultrasound.</p><p><b>RESULTS</b>After contrast injection, vessels of macro- and micro-circulation of the myoma first appeared, followed by the normal myometrium and finally the endometrium. During the washout phase, the myoma exhibited homogeneous enhancement followed by apparent hypoenhancement. The margin of the tumor was depicted clearly. There was no agent perfusion in the benign degenerative or necrotic area. However in sarcomas degeneration, the feeding vessels appeared markedly earlier than those in myometrium. In addition, the tumor exhibited heterogeneous hyperenhancment with no agent perfusion in the center and no membraniform sign was observed in the late phase. In subserous and submucous leiomyomas, the feeding arteries in the pedicle arising from the uterine could be seen. In this study, the diagnostic accuracy of CEUS and conventional US for uterine leiomyomas was 96.7% (160/165) and 82.4% (136/165) respectively.</p><p><b>CONCLUSIONS</b>CEUS can provide a precise description of the leiomyomas vascularization. The specific enhancement pattern may be helpful for the characterization, treatment choice and therapeutic monitoring of leiomyomas.</p>