Preliminary study on thyroid ultrasound image restoration algorithm based on deep learning / 中华超声影像学杂志

Objective:To explore the feasibility of deep learning-based restoration of obscured thyroid ultrasound images.Methods:A total of 358 images of thyroid nodules were retropectively collected from January 2020 to October 2021 at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, and the images were randomly masked and restored using DeepFillv2. The difference in grey values between the images before and after restoration was compared, and 6 sonographers (2 chief physicians, 2 attending physicians, 2 residents) were invited to compare the rate of correctness of judgement and detection of image discrepancies. The ultrasound features of thyroid nodules (solid composition, microcalcifications, markedly hypoechoic, ill-defined or irregular margins, or extrathyroidal extensions, vertical orientation and comet-tail artifact) were extracted according to the Chinese Thyroid Imaging Reporting and Data System (C-TIRADS). The consistency of ultrasound features of thyroid nodules before and after restoration were compared.Results:The mean squared error of the images before and after restoration ranged from 0.274 to 0.522, and there were significant differences in the rate of correctness of judgement and detection of image discrepancies between physicians of different groups(all P<0.001). The overall accuracy rate was 51.95%, the overall detection rate was 1.79%, there were significant differences also within the chief physicians and resident groups (all P<0.001). The agreement rate of all ultrasound features of the nodules before and after image restoration was higher than 70%, over 90% agreement rate for features such as solid composition and comet-tail artifact. Conclusions:The algorithm can effectively repair obscured thyroid ultrasound images while preserving image features, which is expected to expand the deep learning image database, and promote the development of deep learning in the field of ultrasound images.

The predictive study of ultrasound parameters combined with serological indicators for Gleason score risk after prostate cancer surgery / 中华超声影像学杂志

Objective:To establish the prediction model of postoperative Gleason score (GS) risk of prostatic cancer (PCa), and to compare the diagnostic efficacy of the model and each independent risk factor for PCa medium-high risk group.Methods:The clinical data of 362 patients who accepted transrectal prostate biopsy in the Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine from January 2018 to December 2019 were analyzed retrospectively, and a total of 343 patients with prostate cancer who met the enrollment criteria were selected. According to the GS grading system, these patients were divided into low risk group, moderate risk group and high risk group. At first, the single factor analysis and Spearman rank correlation were used to find out the effective indicators with good correlation with GS risk. Then, multiple linear regression equation was applied for multi-factor analysis to obtain the independent risk factors and the prediction model for predicting GS risk, and then the ROC curve was used to compare the diagnostic efficacy of each independent risk factor and prediction model for PCa medium-high risk group.Results:In the single factor analysis, the differences of all indicators in GS risk were statistically significant (all P<0.05). In the correlation analysis with GS risk, except for the indicators of prostate volume (all P>0.05), the other indexes had linear correlations with the different risks of GS (all P<0.05). Among them, the total prostate specific antigen and two-dimensional ultrasound (2D-US) score showed moderate positive correlations( rs=0.402, 0.579, all P<0.001), contrast enhanced ultrasound (CEUS) score showed a high positive correlation ( rs=0.709, P<0.001), and the rest indexes showed low positive correlations. Multiple linear regression was used to obtain two independent risk factors of 2D-US score ( X1) and CEUS score ( X2) for the prediction of GS risk, then, a prediction model was established: Y=0.863+ 0.066 X1+ 0.27 X2, the corresponding linear coefficient differences were statistically significant(all P<0.05). By the ROC analysis, the areas under the curves of 2D-US score, CEUS score and the prediction model were 0.838, 0.906 and 0.907, respectively. Conclusions:2D-US score and CEUS score are independent risk factors for predicting postoperative GS risk, and the diagnostic efficacy of the prediction model is higher than those of the 2D-US score and CEUS score for the medium-high risk group.

Diagnostic performance of ultrasound-based risk stratification systems for thyroid nodules: comparison of the C-TIRADS with the ACR-TIRADS and EU-TIRADS / 中华超声影像学杂志

Objective:To compare the diagnostic values of C-TIRADS, ACR-TIRADS and EU-TIRADS.Methods:According to the classification methods of the 3 guidelines, the ultrasonographic features of 283 thyroid nodules from 266 patients in Sir Run Run Shaw Hospital from January 2019 to June 2020 were analyzed retrospectively. The pathological results were taken as the gold standard, the malignant percentage of different classification was calculated, the ROC curve was plotted, the area under the ROC curve (AUC) and the best diagnostic cut-off value were calculated, and the diagnostic values of the three guidelines were compared. According to the FNA recommendations of the guidelines, the recommended number of thyroid nodules and the detection rate of malignant nodules in different guidelines were analyzed.Results:The AUCs of C-TIRADS, ACR-TIRADS and EU-TIRADS were 0.80, 0.66, 0.61, respectively. The AUC of C-TIRADS was higher than those of ACR-TIRADS and EU-TIRADS ( P<0.001, P<0.001). The best diagnostic cutoff values of C-TIRADS, ACR-TIRADS and EU-TIRADS were 4C, 5 and 5, respectively. Under the critical points, the sensitivities of the 3 guidelines were 95.27%, 98.10%, 99.53%, the specificities were 54.17%, 33.33%, 20.83%, respectively. There was no significant difference in the number of FNA recommendations among the 3 guidelines(all P>0.05), their FNA recommendations were highly consistent (Kappa>0.9). Conclusions:The diagnostic value of C-TIRADS in the classification of benign and malignant thyroid nodules is higher than those of ACR-TIRADS and EU-TIRADS. The best critical value for diagnosis of thyroid nodules is C-TIRADS 4C. The three guidelines are similar in the number of FNA recommendations and the detection rate of malignancy.

Diagnostic value of BRAF V600E mutation combined with 2015 American Thyroid Association ultrasound pattern in patients with cytologically indeterminate thyroid nodule / 中华超声影像学杂志

Objective:To investigate the value of BRAF V600E mutation combined with 2015 American Thyroid Association (ATA) Guidelines ultrasound (US) pattern in fine-needle aspiration (FNA) cytology of thyroid nodules with atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS).Methods:This study retrospectively enrolled 96 consecutive patients with 101 AUS/FLUS thyroid nodules who underwent preoperative US, FNA, and BRAF V600E mutation analysis. All AUS/FLUS nodules were classified based on US pattern-based risk stratification of 2015 ATA Guidelines. With postoperative pathology as the gold standard, the diagnostic value of BRAF V600E mutation, US pattern and the combination of two methods were compared.Results:Postoperative pathology confirmed 33 benign nodules and 68 malignant nodules. The mutation rates of BRAF V600E in AUS/FLUS nodules was 51.5%. The sensitivity, specificity, and accuracy of BRAF V600E in the diagnosis AUS/FLUS nodules were 72.1%, 90.9% and 78.2%, respectively. The ROC curve demonstrated that the best cut-off of US pattern was high suspicion. The sensitivity, specificity, and accuracy of US pattern in the diagnosis of AUS/FLUS nodules were 63.2%, 81.8% and 69.3%, respectively. The accuracy of US pattern in determining AUS/FLUS nodules without BRAF V600E mutation was 70.6%. The sensitivity, specificity, and accuracy of the combination of two methods in the differential diagnosis of AUS/FLUS nodules were 89.7%, 75.8%, and 85.1%, respectively. The combination had the highest sensitivity ( P<0.05). Conclusions:BRAF V600E mutation has a good diagnostic value for differentiating benign and malignant AUS/FLUS nodules. Combined with US pattern, the differential diagnostic value for AUS/FLUS nodules without BRAF V600E mutation can be improved, and the sensitivity can be raised.

Interobserver and inter-modalities agreement of contrast-enhanced ultrasound liver imaging reporting and data system(CEUS LI-RADS) and magnetic resonance imaging liver imaging reporting and data system(MRI LI-RADS) for hepatocellular carcinoma in high-risk patients / 中华超声影像学杂志

Objective:To assess the interobserver and inter-modalities agreement with two non-invasive diagnostic modalities of hepatocellular carcinoma in high-risk patients: contrast-enhanced ultrasound liver imaging reporting and data system (CEUS LI-RADS) and magnetic resonance imaging liver imaging reporting and data system (MRI LI-RADS).Methods:From August 2017 to August 2019, the CEUS and MRI data of patients at high risk for HCC from the Second Affiliated Hospital of Zhejiang University School of Medicine were analyzed retrospectively. A total of 217 lesions in 173 patients were classified according to CEUS LI-RADS v. 2017 or MRI LI-RADS v. 2018, by 4 blinded independent observers with more than 10 years of experience of CEUS or MRI. Interobserver and inter-modalities agreement was assessed with Cohen′s kappa.Results:The interobserver agreement was moderate and comparable for CEUS/MRI LI-RADS category (κ=0.606/0.603), the inter-modalities agreement was moderate for CEUS and MRI LI-RADS category (κ=0.564), LI-RADS 3, M, 4 and 5 by two imaging methods showed that the Kappa values were 0.739, 0.551, 0.734 and 0.592, respectively.Conclusions:The total inter-modalities agreement between CEUS and MRI LI-RADS categories is moderate, while the agreements of LI-RADS 3, 4 are strong, and LI-RADS M, 5 are moderate.

Sonographic features and clinical factors associated with skip metastasis in papillary thyroid carcinoma / 中华普通外科杂志

Objective To explore the sonographic features and clinical factors associated with skip metastasis in papillary thyroid carcinoma (PTC).Methods We reviewed 276 PTC cases pathologically confirmed after operation in our hospital,analyzing the ultrasonographic features and clinical characteristics of primary site and risk factors of skip metastasis.Results The rate of skip metastasis was 16.6％,and level Ⅱ or level Ⅲ were the most common area.In univariate analysis,skip metastasis was associated with tumor location,tumor maximum size,and calcification.Multivariate analysis showed the primary tumor location in the upper portion,tumor size ≤ 10 mm,and microcalcification were independent predictive factors for skip metastasis.Conclusions In papillary thyroid carcinoma,skip metastases rate is high when primary tumor location in the upper portion,tumor size ≤ 10 mm,and there is microcalcification.

Application value of real-time three-dimensional contrast-enhanced ultrasound for morphological assessing of hepatocellular carcinoma before radiofrequency ablation treatment / 中华肿瘤杂志

Objective@#To investigate the evaluating ability of real-time three-dimensional contrast-enhanced ultrasound (RT-3D-CEUS) for morphology of hepatocellular carcinoma (HCC) before radiofrequency ablation (RFA) treatment.@*Methods@#Sixty patients with 88 targeted lesions were enroll in this study, who have received RFA in Hangzhou Xiasha Hospital. The pretreatment imaging data of CEUS and RT-3D-CEUS were retrospective analysis. Morphological features were assessed according to the size and shape of the lesions, and were compared between two modalities with the post-treatment response as the reference standard.@*Results@#The size of lesion measured by CEUS and RT-3D-CEUS was similar in 70 out of 88 lesions (group A). In the other 18 lesions, the size measured by RT-3D-CEUS was larger than that by CEUS (group B). For the shape analysis, 38 lesions were spheroid by CEUS and 34 lesions by RT-3D-CEUS; 47 lesions were oval by CEUS and 41 lesions by RT-3D-CEUS; 3 lesions were irregular by CEUS and 13 lesions by RT-3D-CEUS. There were 78 lesions which shape assessed by two modalities consistently (group A′), and the other 10 lesions with inconsistent shape by two modalities (group B′). Three months follow-up results showed that 4 lesions appeared tumor residue (5.7%) in group A′ and 6 lesions (33.3%) in group B′. There was significant difference between these two groups (P=0.004). In the group A′, there were 6 lesions (7.7%) showed tumor residue, and 4 lesions (40.0%) in group B′. The difference between these two groups was also significant (P=0.012).@*Conclusion@#RT-3D-CEUS could be used to assess the size and shape of HCC accurately which is associated with the response of RFA.

Diagnostic values of BRAFV600E mutation analysis and Bethesda system for reporting thyroid cytopathology in thyroid nodules with TIRADS 4 and 5 / 中华耳鼻咽喉头颈外科杂志

Objective@#To evaluate the diagnostic efficacies of BRAFV600E testing and Bethesda system for reporting thyroid cytopathology (BSRTC) in thyroid nodules with thyroid imaging reporting and data system (TIRADS) category 4 and 5.@*Methods@#A total of 187 thyroid nodules in 187 patients underwent the examinations of ultrasound-guided fine needle aspiration cytology (FNAC) and BRAFV600E mutation were analyzed retrospectively. Receive operating characteristic (ROC) curve was used to investigate the diagnostic values of both methods and the clinical application of BRAFV600E combined with BSRTC was evaluated. SPSS17.0 software was used to analyze the data.@*Results@#Among 187 thyroid nodules, 123 were malignant nodules confirmed with histopathological examination and 64 benign nodules determined by FNAC, histopathological examination, or long-term follow-up. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of BRAFV600E test were better than those of BSRTC [69.1%, 98.4%, 98.8%, 62.4%(χ2=77.3, P=0.000) vs 62.6%, 93.8%, 95.1%, 56.6%(χ2=54.4, P=0.000)]. While the sensitivity, specificity, PPV and NPV of the combined test of BRAFV600E and BSRTC for diagnosis of malignant thyroid nodules were 87.8%, 92.2%, 95.6%, 79.7%(χ2=112.6, P=0.000), respectively. The area under the ROC curve for the combined test was higher than that for each of tests (0.900 vs 0.858 or 0.838).@*Conclusions@#The combined test of BRAFV600E mutation and BSRTC has a higher diagnostic efficacy for malignant thyroid nodules compared with BRAFV600E mutation or BSRTC alone.

Prediction of occult carcinoma in contralateral nodules based on the ultrasonic features of unilateral papillary thyroid carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the occurrence of occult carcinoma in contralateral lobes based on the ultrasonic features of unilateral papillary thyroid carcinoma.@*Methods@#The study included 202 consecutives cases of unilateral papillary thyroid carcinoma with benign nodules in the contralateral lobe identified by preoperative ultrasound or fine-needle aspiration from June 2014 to December 2015. All patients received total thyroidectomies, and with postoperative pathological examination they were divided into two groups, one including 60 cases with positive occult cancer and another one consisting of 142 cases with negative occult cancer. Univariate and multivariate analyses were performed to analyze the sonographic features of unilateral papillary thyroid carcinoma relevant to the occurrence of occult carcinoma in the contralateral nodules.@*Results@#Univariate analysis indicated occult carcinoma in the contralateral lobes was associated with Hashimoto's thyroiditis(χ2=3.955, P=0.047), unclear border (χ2=4.375, P=0.036)and multifocality in the ipsilateral(χ2=7.375, P=0.007), but not with tumors maximum size, location, A/T, shape, internal structure, internal echo, acoustic halo, calcification, capsular invasion and blood flow signal in the lobe with carcinoma on another side. Multivariate analysis showed unclear border (OR=2.727, P=0.010) and multifocality in the ipsilateral(OR=2.807, P=0.005)of carcinoma were independent predictive factor for contralateral occult PTC.@*Conclusions@#Unclear border and multifocality of PTC in the ipsilateral were closely relevant to the occurrence of occult carcinoma in the contralateral nodules.

Application value of contrast-enhanced ultrasonography for assessing the high-risk population of hepatic malignant tumor / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the clinical value of contrast-enhanced ultrasonography (CEUS) in assessing the high-risk population of hepatic malignant tumor (HMT).</p><p><b>METHODS</b>Three hundred patients with high-risk of HMT were enrolled and examined by CEUS. The clinical data of these patients were collected. A comparative analysis was performed to assess the ability of CEUS for detecting and characterizing lesions in the liver. Kappa test was used for assessing the intra-and inter-observer reliability of CEUS.</p><p><b>RESULTS</b>In 87 enrolled patients with 119 malignant lesions detected by contrast-enhanced MRI, 112 lesions were detected by CEUS and 95 lesions were detected by unenhanced ultrasonography (US). The detection rate of CEUS for HMT was significant higher than that of US (94.1% vs. 79.8%; P < 0.01). More HMT lesions were detected by CEUS than by US in 17.2% patients. One hundred and seventy-seven patients with 215 lesions were confirmed by pathological diagnosis or long-time follow-up. There were 118 malignant and 97 benign lesions. The accuracy of CEUS for differential diagnosis of the liver lesions was 91.6% (197/215), significantly higher than that by US (59.1%, 127/215) (P < 0.01). CEUS improved the accuracy for 35.0% (62/177) patients. For 96 patients with 105 lesions detected for the first time, the agreement of diagnosis by CEUS was 92.4% (97/105). The reliability of CEUS was high (Kappainter = 0.866; Kappaintra = 0.934).</p><p><b>CONCLUSIONS</b>CEUS improves the detection rate and diagnostic accuracy rate of the HMT high-risk population, with a high agreement for diagnosing the new lesions. CEUS may be considered as a first-line method to assess the high-risk population of HMT conveniently, accurately and reliably.</p>

Capsular contracture in augmentation mammaplasty with smooth versus textured breast implants: a Meta analysis / 中华医学美学美容杂志

Objective To analyze the incidence of capsular contracture in breast augmentation with smooth versus textured breast implants using a Meta method.Methods Terms such as breast augmentation, capsular contracture, smooth implant, textured implant, breast implant were searched in databases such as MEDLINE,EMBASE,Cochrane Library,CBM and VIP.Documents about breast augmentation with textured and smooth implants were totally collected,and the data of these trials were extracted to obtain a pooled odds ratio of capsular contracture and other complications.Meta analyses were performed by RevMan 5.2 software to estimate the combined effect values.Results Eleven clinical controlled trials were included.The results of meta analysis showed that textured implants group and smooth implant group presented the risk of capsular contracture combined OR=0.32 (95％ CI,0.18 to 0.58,P=0.0002),and also presented the risk of other complications combined OR=1.31 (95％ CI,0.96 to 1.77,P=0.09).Conclusions Compared with smooth implants,textured implants reduce the risk of capsular contracture after breast augmentation.

Clinical value of high frequency ultrasound guided fine needle aspirates(FNA) and FNA-thyroglobulin detection for diagnosing cervical metastatic lymph nodes in patients underwent thyroidectomy for papillary thyroid carcinoma / 中华超声影像学杂志

Objective To investigate the diagnositc value of high frequency ultrasound guided fine needle aspirates (FNA) and thyroglobulin (Tg) in fine-needle aspirate fluid (FNA-Tg) measurement for detecting metastatic lymph nodes in patients underwent thyroidectomy for papillary thyroid carcinoma (PTC).Methods Sixty-five patients with 79 suspected metastatic lymph nodes were retrospective analysis in this study.FNA for suspected lymph nodes was performed guided by high frequency ultrasound and FNATg was measured.The histopathologic diagnosis for all of the suspected lymph nodes was obtained after lymphadenectomy.Results By histopathologic diagnosis,62 lymph nodes were positive metastasis,while 17 were negative metastasis.Fifty-four lymph nodes were diagnosed as positive metastasis and 25 as negative metastasis by FNA.The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of FNA for assessing cervical metastatic lymph nodes from PTC were 89.87％ (71/79),87.10％ (54/62),100％ (17/17),100％ (54/54) and 68.00％ (17/25),respectively.Sixty-five lymph nodes were diagnosed as positive metastasis and 14 as negative metastasis by FNA-Tg.The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of FNA-Tg were 96.20％ (76/79),100％ (62/62),82.35％ (14/17),95.38％ (62/65) and 100％ (14/14),respectively.There was no significant difference between FNA and FNA-Tg for evaluating cervical metastatic lymph nodes from PTC (x2 =1.454,P =0.228).Eight positive metastatic lymph nodes which were missed by FNA were corrected diagnosed by FNA-Tg measurement.Conclusions Both FNA and FNA-Tg are effective methods for assessing cervical metastatic lymph nodes from PTC postoperatively,and these two methods could be combined for early and accurate evaluating the lymph nodes state.

Preliminary study of three-dimensional speckle tracking echocardiography in evaluation of left ventricular systolic longitudinal strain in patients with uremia / 中华超声影像学杂志

Objective To evaluate the characteristics of left ventricular systolic longitudinal strain in uremic patients and its relationship with dialysis time using three-dimensional speckle tracking echocardiography (3D-STE).Methods Forty-six uremic patients were divided into three groups according dialysis time (ranged 0-5 years):group A (≤1 year),group B (1 year＞time ≤3 years),group C (3 years ＞time≤5 years),group D was control group.The dynamic images of apical four chamber view were displayed and apical full-volume images were obtained and saved in all subjects using a full volume matrix probe.The original data was recorded and was analyzed by using off-line 3DT analysis software (TomTec 4D MV-Assessment).The longitudinal peak systolic strain and 16 segment systolic strains and strain mean value in 16 segment of left ventricular were acquired and compared.Results The peak strain of apical segment was lower than that of the basal segment and the middle segment and it had an increasing trend from the apical segment to the basal segment in three uremia groups.Instead,it had a decreasing trend from the apical segment to the basal segment in control group.But the differences were not statistically significant.The longitudinal peak systolic strain value,16 segment strain value and mean value of 16 segment strain all were lower in three uremic groups than those of control group.Every segment of 16 segment stain value in group A was higher than those of group B and C.There was no difference in every segment between B and C group in addition to basal and middle segment of anterior septum.Conclusions 3D-STE could evaluate the left ventricular systolic function in uremic patients and the cardiac function could be partly protected by regular dialysis treatment.

Quantitative assessment of ventricular-arterial coupling in patients with uremia / 中华超声影像学杂志

Objective To investigate the clinical value of quality intima-media thicknes (QIMT),quality arterial stiffness(QAS) and XStrain in assessing the ventricular-arterial coupling (VAC) in patients with uremia.Methods Sixty-five patients with uremia and 30 normal subjects were enrolled in this study as the uremic group and control group respectively.Ultrasound examination for the cardiac and carotid artery was performed and some parameters were obtained,such as left ventricular ejection fraction(LVEF),E/e,Tei index,stiffness (β),compliance coefficinet (CC),pulse wave velocity (PWV),intima-media thicknes (IMT),strain,and so on.The sum of left ventricular systolic radial strain and carotid arterial diastolic radial strain was used as a new parameter (VACs) for assessing VAC.The correlation between VACs and VACv,a traditional method to evaluate VAC,was analyzed.The parameters obtained by ultrasonic techniques were compared between two groups.The intra-and inter-observer reliability of XStrain was assessed by intraclass correlation coefficient.The multiple linear regression and ROC curve were used to analyze the independent factor of cardiovascular dysfunction.Results ①The pulse pressure,E/e,Tei index,as well as β,PWV and IMT were larger in uremic group than control group significantly (P ＜0.05).②The function of VAC was decreased in uremic group,and the VACv and VACs were lower than control group significantly (P ＜0.05).③There was strong positive relation between VACs and VACv (r =0.908,P =0.000).The reproducibility of XStrain technique was well.④VACs,β,VACv and PWV could be considered as independent factor of cardiovascular dysfunction and performance of VACs was the largest (standardized coefficient was-0.582).A cutoff value of VACs for assessing cardiovascular dysfunction was less than 23.60,which had both higher sensitivity and specificity (96.4％,81.1％).Conclusions The QIMT,QAS and XStrain can be used to assess cardiovascular structure,function and VAC accurately and globally,which can be consider as an effective method for detecting cardiovascular complication and improving prognosis of uremic patients.

Preliminary application of double contrast-enhanced ultrasonography to assess the peripancreatic vascular invasion of pancreatic carcinoma / 中华超声影像学杂志

Objective To investigate the clinical value of double contrast-enhanced ultrasonography (DCEUS) in assessing the peripancreatic vascular invasion of pancreatic carcinoma.Methods Twenty-eight patients with pancreatic cancer confirmed by postoperative pathology were examined by DCEUS preoperatively.The relationship between neoplasms and peripancreatic vessels was analyzed for assessing whether vascular invasion of pancreatic cancer had occurred.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of DCEUS in evaluating vascular involvement were calculated by using the surgical results as a gold standard.Kappa test was used for assessing the intra- and interobserver reliability of DCEUS.Results In total 28 patients,21 cases were diagnosed as vascular invasion,whereas,7 cases were noninvasive by surgical results.By DCEUS,18 cases were assessed as positive involvement of vessels,whereas,10 cases were negative.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of DCEUS in evaluating vascular involvement were 85.71 ％,100％,100 ％,70.00 ％ and 89.29 ％ respectively,and with higher reliability (Kappainter =0.75,Kappa =0.80).Conclusions DCEUS could be considered as a novel method to assess vascular invasion of pancreatic carcinoma accurately and reliably.

Study on hypovascular tumor' s treatment with targeted mierobubbles combined with ultrasonic abrupted destroy / 中华超声影像学杂志

Objective To assess the therapeutic efficacy of colonic tumor with targeted microbubbles encapsulated VEGFR2 monoantibody (mAb) combined with ultrasonic abrupted destroy.Methods Seventeen Balb/C nude mice with subcutaneous colonic carcinoma xenografts were divided into three groups:group A (5 mice) underwent contrast-enhanced ultrasonography (CEUS) examination and sham ultrasonic abrupted destroy;group B (6 mice) underwent lipid-microbubbles administration combined with ultrasonic irradiation;group C (6 mice) underwent VEGFR2 monoantibody-loaded microbubbles injection combined with ultrasonic irradiation.Red fluorescent protein(RFP) was labeled to all the nude mice model.Both CEUS and flurography were performed before and one week after abrupted destroy.The size,fluroscent area and fluroscent intensity(FI) and vessel density (VD) of each tumor were measured and compared.Results The parameters of length,fluroseent area,FI and VD of each tumor before abrupted destroy were no significant difference among three groups ( P ＞0.05).Parameters of post-sham ultrasonic abrupted destroy in group A were higher than those before sham ultrasonic abrupted destroy ( P ＜0.05).FI and VD in group B were significantly lower than those after abrupted destroy( P ＜0.05).There were no difference of length,fluroscent area of tumor in group B between pre- and post- ultrasonic abrupted destroy (P ＞0.05).Length,fluroscent area,FI and VD of each tumor in groups C were decreased significantly compared with post ultrasonic abrupted destroy ( P ＜0.01 ).There were significant difference of length,fluroscent area,FI and VD of each tumor among groups after ultrasonic abrupted destroy( P ＜0.05).Conclusions VEGFR2 mAb-loaded lipid microbubble combined with ultrasonic abrupted destroy can improve the therapeutic efficacy of colonic tumor.

Clinical values of intraoperative real-time three-dimensional transesophageal echocardiography for surgery in patients with mitral valve prolapse / 中华超声影像学杂志

Objective To investigate the value of the intraoperative real-time three-dimensional transesophageal echocardiography (RT 3D-TEE) in therapeutic application of surgery for the mitral valve prolapse.Methods Thirty-five patients underwent surgical treatment were diagnosed as mitral valve prolapse by 2-dimensional transthoracic echocardiography (2D-TTE),with or without ruptured chordae tendineae.RT 3D-TEE was performed for assessing the segment of prolapse and its complications before cardiopulmonary bypass and after heart resuscitation respectively.The echocardiographic results were compared with the surgical findings.Results The accuracy of RT 3D-TEE to identify segments with prolapse was significantly higher than that of 2D-TTE (91.4％ vs 82.9％,P =0.003).RT 3D-TEE was more accurate than 2D-TTE for identifying ruptured chordae tendineae,vegetation and thrombus since higher sensitivity,specificity and Youden index.Among all 35 patients,valvuloplasty was performed in 28 cases,whereas,only 7 cases underwent replacement of prosthetic valves.Three patients were benefited by accurate evaluation of therapeutic effect using RT 3D-TEE in time.ConclusionsIntraoperative RT 3D-TEE can be used to provide “ surgical view”,acquired adequate valuable information of mitral valve,and more reliable functional and anatomical assessment of the mitral valve components and its geometry.Suitable surgical intervention can be designed for improving outcomes of patients.

Application of double contrast-enhanced ultrasonography to access the lymph nodes metastasis of gastric carcinoma / 中华超声影像学杂志

Objective To investigate the clinical value of double contrast-enhanced ultrasonography (DCUS) in diagnosing lymph nodes metastasis of gastric carcinoma.Methods One hundred and sixteen patients with gastric cancer diagnosed by gastroscope and confirmed by pathology after operation were examined by DCUS preoperatively.The enhanced characteristic of gastric carcinoma tissues was assessed by autotracking contrast quantification(ACQ) software.The baseline intensity(BI), peak intensity(PI), arrival time(AT) and time to peak(TTP) of gastric cancer was measured automatically,and the enhanced intensity (EI) and wash-in time(WIT) of gastric cancer was calculated manually (EI=PI-BI; WIT=TTP-AT).All of the subjects were divided into two groups according to their lymph nodes status postoperatively:group N1,sixty-nine patients with lymph nodes metastasis; and group N0, forty-seven patients without lymph nodes metastasis.The DCUS quantitative analysis and pathological results of these two groups were compared each other.The Kappa's test was used for inter-rater reliability.Results BI of group N1 in the gastric carcinoma tissues was lower than that of group N0 significantly [(1.41 ± 1.56)dB vs (3.92 ± 2.82)dB, t = - 4.81, P = 0.000].EI of group N1 in the gastric carcinoma tissues was higher than that of group N0 significantly [(20.67±3.71)dB vs (14.12±3.75)dB, t=7.31, P=0.000].Moreover, there was a significant difference of WIT in the gastric carcinoma tissues between these two groups[(9.12±2.99)s vs (10.88±3.05)s, t =-2.43, P=0.018].The WIT in patients with lymph nodes metastasis was shorter than that without it. A cut-off value ＞17.05 dB of EI in gastric cancer tissues for assessing the lymph nodes metastasis had a sensitivity of 80.50% and specificity of 76.70% respectively obtained by the area under the ROC curve. The Kappa value of this method was 0.88.Conclusions EI of gastric cancer tissues can be considered as a new potential index to evaluate the lymph nodes metastasis of gastric cancer.

Pilot study of double contrast ultrasonography for pathological typing of advanced gastric cancer / 中华超声影像学杂志

usions DCUS could initial estimate the pathological typing of advanced gastric caner before operation.

Pilot study of double contrast ultrasonography for differentiation degree of gastric cancer / 中华超声影像学杂志

Objective To investigate the value of oral and intravenous contrast enhanced ultrasonography-double contrast ultrasonography (DCUS) in the evaluation of differentiation degree of gastric cancer. Methods Fifty-three patients who had been diagnosed as gastric cancer by gastroscope and confirmed by pathology after operation were examined by DCUS, and they were divided into moderately to well differentiated group and poorly differentiated group. The correlation of size and enhancement features of the lesions was compared with differentiation degree of gastric cancer. Results The size and enhancement distribution of lesions were markedly correlated with the degree of differentiation. The baseline intensity(BI)in poorly differentiated group was lower than that in well and moderately differentiated group[(0.52±1.12)dB vs (1.53±1.87) dB, P<0.05], but enhanced intensity(EI) was higher than that in the second group [(26.22±3.69)dB vs (23.69±5.02)dB, P<0.05]. Conclusions DCUS could initial evaluate the degree of differentiation of gastric cancer before operation.