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Objective:To explore the diagnostic value of contrast-enhanced ultrasound combined with fine-needle aspiration biopsy and BRAF gene detection for TI-RADS category 4 nodules.Methods:The clinical datas of 80 patients who underwent surgery in the First Affiliated Hospital, Zhejiang University School of Medicine and Lishui People′s Hospital and diagnosed with TI-RADS 4 thyroid nodules from January 2019 to January 2020 were retrospectively analyzed. All patients received contrast-enhanced ultrasound combined fine-needle aspiration biopsy and BRAF gene detection, the ROC curves were plotted, the area under the ROC curve(AUC) and the best diagnostic cut-off values were calculated, and the application value of ultrasound-enhanced contrast, fine-needle aspiration biopsy and BRAF gene detection were compared.Results:Based on the results of pathological diagnosis, in diagnosing TI-RADS 4 thyroid nodules, the sensitivity, specificity and accuracy were 77.61%, 70.97% and 75.51% for contrast-enhanced ultrasound, respectively; 80.60%, 74.19%, and 78.57% for ultrasound-guided fine-needle aspiration biopsy, respectively; 79.10%, 96.77%, and 84.69% for the BRAF gene test, respectively; and 98.51%, 70.97% and 89.80% for the combined diagnosis, respectively. The AUC was 0.790 for contrast-enhanced ultrasound, and 0.774 for ultrasound-guided fine-needle aspiration biopsy, 0.799 for BRAF genetic testing, and 0.847 for combined testing. The diagnostic value of combined diagnosis was significantly higher than other diagnostic methods ( P<0.05). Conclusions:Contrast-enhanced ultrasound combined with fine-needle aspiration biopsy and BRAF gene detection is valuable for the diagnosis of TI-RADS 4 class thyroid nodules and improves the preperative diagnosis.
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Objective:To explore the value of constrast-enhanced ultrasound-micro flow imaging (CEUS-MFI) in the differential diagnosis of benign and malignant renal tumors.Methods:Totally 96 patients with renal space occupying found in two-dimensional gray-scale ultrasound examination in the First Affiliated Hospital, College of Medicine, Zhejiang University from November 2020 to August 2021 were collected, and 97 lesions were examined by CEUS-MFI and constrast-enhanced ultrasound(CEUS), respectively. The microvascular morphology and contrast-enhanced characteristics of renal tumors were recorded, ROC curves were constructed, and the diagnostic efficacies of the two methods were compared.Results:In the CEUS examination, the enhancement modes of malignant tumors were mainly fast wash-in(52/66, 78.8%) and fast wash-out (49/66, 74.2%) and high perfusion (56/66, 84.8%), and ring enhancement can be seen in 48.5%(32/66) of the lesions. The enhancement patterns of benign tumors were mainly slow wash-in (17/31, 54.8%) and slow wash-out (20/31, 64.5%) and low perfusion (18/31, 58.1%), and no circular blood flow was found in 31 lesions.In the CEUS-MFI examination, the vascular morphology of malignant tumors was mainly irregular (46/66, 69.7%), 93.9%(62/66) of malignant tumors had circular blood flow. Most of benign tumors were of linear vascular structure(12/31, 38.7%) and dendritic vascular structures (14/31, 45.2%), 93.5% (29/31) of benign tumors showed no circular blood flow. The detection rate of the annular blood flow in malignant tumors by CEUS-MFI was higher than that by CEUS, and the difference was statistically significant (93.9% vs 48.5%, P<0.001). The accuracy, sensitivity, and specificity of diagnosing renal tumors for using CEUS-MFI were 90.7%, 93.9% and 83.8%, respectively; and 84.5%, 92.4% and 67.7%, respectively, for using CEUS. The areas under the ROC curve were 0.898 and 0.814 for using CEUS-MFI and CEUS, respectively, the difference between the two techniques was not significant ( P=0.151). Conclusions:CEUS-MFI can sensitively and clearly display the microvascular morphology inside the tumor, and greatly improve the detection rate of annular blood flow in renal malignant tumors, which provides a new method for clinicians to identify benign and malignant renal tumors.
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Objective:To compare the efficacy of anhydrous ethanol and lauromacrogol in the treatment of ovarian endometriosis cyst (OEC), and to provide evidence for more effective use of these two sclerotic drugs.Methods:Thirty-three cysts in 30 patients with OEC, who were admitted to Taizhou Hospital of Zhejiang Province from February 2017 to June 2018, were treated by ultrasound interventional therapy, followed by catheter aspiration, saline cavity cleaning, anhydrous ethanol rinsing and sclerotherapy, and lauromacrogol alcohol 1∶1 mixed solution retained in the capsule (mixed group). The therapeutic effects were observed 6 and 12 months after operation. A total of 30 OEC in 28 cases admitted to the same hospital from 2013 to 2015 were retrospectively analyzed after similar treatment steps, but the intracapsular retention fluid was anhydrous ethanol (ethanol group). A total of 28 OEC in 26 patients admitted to the same hospital from 2015 to 2017 were washed with normal saline, then washed with lauromacrogol and retained in the capsule with lauromacrogol (lauromacrogol group). The therapeutic effects of 6 and 12 months after treatment between the three groups were compared.Results:According to the classification of cure, marked effect and inefficacy, there was a weak correlation among the three groups. The mixed group did not tend to be ineffective, while the lauromacrogol group tended to be ineffective 6 and 12 months after treatmen.the difference was statistically significant (adjusted standardized residual >2). According to the total effective (cure+ markedly effective) and ineffective classification, the effective rate of the mixed group was significantly higher than that of the lauromacrogol group ( P<0.016 7). There was no significant difference for the effective rate between the mixed group and the ethanol group, and between the ethanol group and the lauromacrogol group ( P>0.0167). Conclusions:The retention of ethanol-lauromacrogol mixture in the capsule of sclerotic OEC, after pre-rinsing with anhydrous ethanol is helpful to improve the curative effect of OEC and give full play to the therapeutic effect of common sclerosing agents used in ultrasound intervention.
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Objective@#To explore the value of full-angle ultrasonic shear wave elastography in differentiating benign and malignant breast diseases.@*Methods@#After constructing a new ultrasonic shear wave elastography system, the clinical and ultrasonographic data of 74 patients with mass breast diseases were retrospectively analyzed. The patients were divided into benign group and malignant group according to the pathologic results. Meanwhile, the significant indicators of difference were screened out for ROC analysis, and the curve characteristics were compared.@*Results@#Eratio-45°, Eratio-225°, Emax-90°, Emax-270°, Emean-0° and Emean-180° were significantly different between the benign and malignant groups. The AUC of ROC were 0.71, 0.81, 0.83, 0.80, 0.86 and 0.83, respectively. The results of model evaluation showed that the specificity of model-Eratio-45° was relatively low (0.42), while the other 5 indicators showed high specificity (0.73-0.78).@*Conclusions@#The full-angle ultrasonic shear wave elastography can provide more information for differentiating benign from malignant breast diseases.
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Objective To explore the value of full-angle ultrasonic shear wave elastography in differentiating benign and malignant breast diseases.Methods After constructing a new ultrasonic shear wave elastography system,the clinical and ultrasonographic data of 74 patients with mass breast diseases were retrospectively analyzed.The patients were divided into benign group and malignant group according to the pathologic results.Meanwhile,the significant indicators of difference were screened out for ROC analysis,and the curve characteristics were compared.Results Eratio-45°,Eratio-225°,Emax-90°,Emax270°,Emean-0° and Emean-180° were significantly different between the benign and malignant groups.The AUC of ROC were 0.71,0.81,0.83,0.80,0.86 and 0.83,respectively.The results of model evaluation showed that the specificity of model-Eratio-45° was relatively low (0.42),while the other 5 indicators showed high specificity (0.73-0.78).Conclusions The full-angle ultrasonic shear wave elastography can provide more information for differentiating benign from malignant breast diseases.
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Objective To observe the value of virtual tough tissue imaging quantification (VTIQ) in differential diagnosis of thyroid imaging reporting and data system(TI-RADS) 4 thyroid nodules.Methods A total of 185 patients with 192 TI-RADS 4 nodules were included in this study.The nodules were divided into three groups according to the maximum size as follows:Group Ⅰ,the maximum size≤0.6 cm;Group Ⅱ,0.6 cm＜ the maximum size≤ 1.0 cm;Group Ⅲ,the maximum size ＞ 1.0 cm.Shear wave velocities (SWV) of nodules were measured by means of VTIQ technique.With pathological diagnosis as the gold standard,SWV value of benign and malignant nodules were analyzed and ROC curve was drawn to assess the diagnostic efficiency.Results By the ROC curve test,at SWV cut-off values of 2.44 m/s for group Ⅰ and group Ⅱ,2.49 m/s for group Ⅲ,the sensitivity were 79.0 ％,76.0 ％,88.6％,specificity were 88.6％,89.5 ％,93.7 ％,accuracy were 83.5 ％,81.8 ％,90.1％,Youden index were 0.68,0.66,0.82,respectively.Conclusions VTIQ can reflect the hardness of TI-RADS 4 nodules,the value of the differential diagnosis of such nodules is high,convenient,noninvasive and not limited by the size of nodules.
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Objective To evaluate the relation of appearance of contrast-enhanced ultrasonography (CEUS) to Ki 67 and C-erbB-2 in breast invasive ductal carcinoma and ductal carcinoma in situ.Methods The appearance of CEUS in 29 patients with breast invasive ductal carcinoma and 12 patients with ductal carcinoma in situ,which was diagnosed by surgery or biopsy,was analysed retrospectively.The Ki-67 and CerbB-2 were measured by immunohistochemical test.The relation of the above two factors to appearance of contrast ultrasonography was analysed.Results The positive rate of Ki-67 was 68.97％ (20/29) in patients with breast invasive ductal carcinoma and 16.67％ (2/12) in patients with ductal carcinoma in situ.The positive rate of C-erbB-2 was 48.2％ (14/29) in patients with breast invasive ductal carcinoma and 42.6％ (5/12) in patients with ductal carcinoma in situ.The masses had a common appearance of high enhance in patients with breast invasive ductal carcinoma and ductal carcinoma in situ,which was not correlated to C-erbB-2.The Ki-67 was significantly higher in patients with ductal carcinoma in situ than that in patients with breast invasive ductal carcinoma,the appearance of CEUS was correlated to Ki 67.Conclusions The features of micro-vessels by CEUS were correlated to Ki-67 in patients with breast invasive ductal carcinoma and ductal carcinoma in situ.
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Objective To evaluate the safety of percutaneous radiofrequency ablation (RFA ) in hepatic malignant tumors under the guidance of ultrasonography .Methods The clinical data and the follow‐up radiographic images of the patients with hepatic malignant tumors treated by percutaneous RFA between January 2012 and February 2014 were retrospectively reviewed ,and the major or minor complications of RFA were both calculated .Results 1 568 lesions were ablated by 1 080 percutaneous RFA procedures in 900 patients with hepatic malignant tumors under the guidance of the sonography .The average size of the tumors was (2 6.± 1 2.)cm .The total complications rate of 1 080 RFA procedures was 5 9.3% (64/1 080) , which including intra‐abdominal bleeding 2 7.8% (30/1 080) ,hepatic abscess 0 7.4% (8/1 080) ,biliary tract damage 0 6.4% (7/1 080 ) ,vascular damage 0 5.6% (6/1 080 ) ,tract seeding 0 4.6% (5/1 080 ) ,pleural hemorrhage 0 3.7% (4/1 080) ,gastrointestinal damage 0 1.8% (2/1 080) ,hepatic encephalopathy 0 0.9% (1/1 080) ,and death 0 0.9% (1/1 080) .While major complications was 1 9.4% (21/1 080) vs minor 3 9.8% (43/1 080) .Sixty three patients with complications recovered after treatments including blood transfusion , ablation ,surgery ,interventional drainage procedure and liver transplantation ,only one patient died for irreversible liver failure .Conclusions RFA for hepatic malignant tumors under the guidance of sonography is a safe method with lower complications rate ,however ,the potential major complications and the indications of RFA liver malignant tumors should be carefully focused on .
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Objective To evaluate the short-term efficiency and risk factors for effects after percutaneous radiofrequency ablation (RFA) for hepatic malignant tumors under the guidance of sonography.Methods The clinical data and the follow-up radiographic images of the patients with hepatic malignant tumors treated by percutaneous RFA were reviewed between June 2011 and May 2012,and the short-term incomplete ablation rate,recurrance rate and tumor progression rate were calculated,and the factors affecting the incomplete ablation rate,recurrence rate and progression rate were analyzed.Results 610 lesions were ablated in the total of 462 RFA procedures for 405 patients under the guidance of sonography with percutaneous method.The average size of the tumor was (2.5 ± 1.1)cm.During at least 3-month follow-up,complete and incomplete ablation rate was 89.2％ (544/610) and 10.8％ (66/610)separately,and recurrance rate and progression rate of tumor was 17.5％ (81/462) and 23.8％ (110/462).The numbers (≥3) and the size (≥3 cm) and the location (close to vessels) of the lesions reduced the complete ablation rate.The numbers (≥3) of lesions affected the recurrence rate and progression rate of lesions as only risk factor.Recurrent hepatocellular carcinoma (HCC) and metstasis from gastrointestine or non-gastrointestine had higher recurrence rate and progression rate comparing with primary HCC.Conclusions RFA can effectively control local progression of hepatic maglinant tumors,and the tumor's size,number and location close to velssels could effect complete ablation rate,the number of tumors could effect the recurrence and porgression rate.Recurrent HCC and metstasis from gastrointestine or nongastrointestine had higher recurrence and progression rate comparing with primary HCC.
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Objective To evaluate the diagnostic value of contrast enhanced ultrasonogrphy(CEUS) and quantitative analysis in differentiating between thyroid solid malignant masses and solid benign masses.Methods 40 patients with thyroid solid mass were enrolled into this prospective study between March 2012 and June 2012.A total of 45 thyroid solid masses were evaluated by CEUS,and the final pathology diagnosis was confirmed by core biopsy or thyroidectomy.The diagnostic yield of enhancement patterns and quantitative parameters were assessed for differentiating between the solid malignant and benign masses.Results Enhancement patterns were classified into five types (nonenhancement,early hypo enhancement,hypo enhancement,isoenhancement,hyperenhancement).Two malignant masses had nonenhancement pattern,and 6 malignant masses had early hypoenhancement pattern,and 14 malignant and 4 benign masses had the hypo enhancement pattern,and 5 malignant and 7 benign masses had the isoenhancement pattern,and 1 malignant and 6 benign masses had the hyperenhancement pattern.There was a significant difference between malignant and benign enhancement patterns of thyroid solid masses (x2 =12.184,P =0.016).Nonenhancement,early hypoenhancement and whole phase hypoenhancement pattern predict thyroid solid malignant masses with sensitivity of 78.5 ％ and specificity of 76.5 ％.Among seven quantitative parameters used to predict thyroid malignant mass,the relative maximum intensity (IMAX％) of lesions had highest value in differentiating between the malignant and benign masses with sensitivity of 80.8 ％ and specificity of 82.6％,and area under receiver operating curve (AUC) of the IMAX％ was 0.878.RT (rising time),TTP (time to peak intensity),mTT (mean transit time) had almost non differentiation value with AUC of 0.619,0.601,0.656 separately.And mTT-Ratio (mTT of lesion/mTT of parametric area),RT-Ratio (RT of lesion/RT of parametric area),TTP-Ratio (TTP of lesion/TTP of parametric area) had less differential diagnostic value with AUC of 0.749,0.744,0.704 comparing with IMAX％.Conclusions Nonenhancement and early or whole phase hypoenhancement could be characteristic enhancement pattern of malignant thyroid solid masses,and IMAX％ had good diagnostic value in differentiating between malignant and benign masses among the quantitative parameters.
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ObjectiveTo investigate the clinical features and ultrasound imaging characteristics of retroperitoneal fibrosis (RPF),and to find out the value of ultrasound in monitoring the outcome of this disease.MethodsTwelve patients with retroperitoneal fibrosis proven by operation or biopsy were analyzed retrospectively.Their abdominal ultrasound images before and after treatments were studied,especially the severity of renal collecting system separation,the abnormal echo group around the retroperitoneal organs which including the abdominal aorta,the mesenteric artery and vein,the iliac vessels,the inferior vena cava,the bilateral ureters,renal arteries and veins.ResultsAll patients had abnormal separation in renal and ten patients were detected corresponding dilatation in unilateral or bilateral ureters.Seven patients were detected hypoechoic and heterogeneous clumps located in retroperitoneal area,which were around retroperitoneal blood vessels,kidneys or ureters.Three patients received resection to rule out cancer,two patients had ultrasound-guided biopsy and took hormone therapy after diagnosis,seven patients undertook ureteral release surgery and inserted double J stent combined with hormone therapy.Two months later,ultrasound showed the lesions significantly disappeared or reduced size compared with before treatments.It was also found that the majority of patients had hydronephrosis relieved and renal function recovered.Conclusions Ultrasound can help diagnosing retroperitoneal fibrosis,and monitor the outcome of this disease.
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Objective To summarize the manifestation of autoimmune pancreatitis (AIP) on ultrasound and contrast-enhanced ultrasonography (CEUS).MethodsThe 2D ultrasound and CEUS images of 16 patients With AIP were retrospectively analyzed.Results On 2D ultrasound,AIP presented as diffusely(15 cases) or focally (1 case)swelling with low echo.13 cases revealed dilatation of the biliary tract.The choledochal wall showed thickening with a sandwich-pattern in 9 cases,which was also shown in 3 intrahepatic bile ducts and 3 gall bladders.On CEUS,6 AlP of diffuse form enhanced simultaneously and homogeneously.1 AIP with enlarged pancreatic head enhanced simultaneously,the enhanced degree in pancreatic head was higher than that of the surrounding pancreatic tissue in the vascular phase and equal to that in the parenchymatous perfusion phase.1 AIP of focal form enhanced slightly late compared with normal pancreatic tissue and the enhanced degree was lower in the vascular phase,while in parenchymatous perfusion phase.the pancreatic tissue enhanced homogeneously.ConclusionsThe manifestation of AIP on ultrasound and CEUS had some features which were helpful in diagnosis of AIP.
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Objective To investigate the utility of serum prostate specific antigen(PSA) density (PSAD),prostate antigen transition zone density(PSAT) and the ratio of free/total PSA with PSAD [(F/T)/PSAD] in the diagnosis of prostatic carcinoma (PCa) by three-dimensional ultrasonography.Methods Seventy-eight patients (serum prostate-specific antigen between 4-20 μg/L ) were involved.The prostatic volume and its transition zone volume were measured by three-dimensional ultrasonography.Then the relative parameters of PSA [PSAD,PSAT and (F/T)/PSAD] were calculated.Pathologic types were determined by using needle biopsy of prostate.Results Among them,27 patients were suffering from PCa,while the other 51 benign prostate hypertrophy (BPH).The difference of PSAD,PSAT and (F/T)/PSAD between PCa and BPH had arrived statistical significance (P0.20,PSAT>0.33,(F/T)/PSAD<0.8.Conclusions When the serum PSA level is between 4 μg/L and 20 μg/L,PSAD,PSAT and (F/T)/PSAD are of significant value to differentiate PCa from benign prostatic hyperplasia patients.The data are more reliable if prostatic volume are calculated by three-dimensional transrectal ultrasonography.
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Objective To evaluate the reliability of benign nodules diagnosed by ultrasound and analyze the probable factors of infecting the BI-RADS ultrasound categorization of breast lesions. Methods A total of 792 cases with initial category 3 assessments on BI-RADS ultrasound categorization consistent with more than 2 years follow-up or pathologic results were contained. The reliability of probable benign lesions were studied retrospectively,and several factors that could influence the categorization were explored such as age,breast lumps size,multiplicity,palpability,and US radiologist's experience referring to ACR-BI-RADS and the new categorizations recommendation. Results Of 792 breast nodules, 781 (98.6%) were benign and 11 (1.4%) were malignant. If the new categorizations recommendation was applied, 35. 1% (278/792) of all cased would have been upgraded to BI-RADS 4,81. 8% (9/11)of malignant tumors would have been found. The breast masses diagnosed by the junior radiologists were more frequently upgraded to BI-RADS 4 than senior radiologists' findings (P <0. 05), the nodules in women 40 years or older and multiple lesions were more frequently upgraded to category 4 (P <0. 01). The presence of palpability and mass size had on significantly influence the BI-RADS US categorization of breast nodules. Conclusions BI-RADS-Ultrasound categorization is relatively reliable to diagnose breast benign nodules. The multiplicity of breast nodules,patient's age and US radiologist's experience were found to have significant influences on the categorizations of probably benign breast nodules.
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Objective To evaluate the safety, feasibility and clinical value of real-time navigation system with CT/MR and sonographic images for percutaneous ablation of hepatic malignancies poorly defined on conventional ultrasonography. Methods Fifteen patients with 22 hepatic malignant lesions underwent percutaneous ablation guided by virtual navigation system with ultrasonography. Treatment response was assessed by the contrast CT/MR followed up one month after procedures. Results Complete tumor necrosis was achieved in 20 lesions, but 2 lesions showed residual tumor in the ablation zone. No treatment associated complications were found. Conclusions The application of virtual navigation system is of clinical value in localization of lesions, guidance of biopsy and assessment of the interventional therapy in patient with hepatic malignancies, particularly for those with poorly identified lesions by conventional ultrasonography.
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Objective To build the schema of combination between commercially available ultrasound contrast agent SonoVue and self-made liposomes,and determine its efficiency. Methods Microbubbles was labeled by carbocyanines dye DiI. The effect of DSPE-PEG-FITC labelling was determined by flow cytometer to evaluate the insertion efficiency of the amphipathic molecule DSPE-PEG(2000)Amine into lipid monomers shell. Aminated fluorescent liposomes were prepared by rotary evaporation and their size were determined by laser particle size analyzer. Liposomes and microbubbles were combined by two-step glutaraldehyde crosslinking. The impact of liposome concentration and DSPE-PEG (2000)Amine concentration on the construction efficiency of the complex of SonoVue conjugated to liposomes was determined by flow cytometer and multifunctional ELIASA respectively. Results The configuration of SonoVue microbubbles labeled by DiI and DSPE-PEG-FITC showed fine. The combination between liposomes and microbubbles was realized by glutaraldehyde crosslinking. The flow cytometer showed that 200 μl liposomes solution per 200 μl microbubbles suspension was the optimal proportion, with the peak positive rate as (87.80 ± 5.91)%. Multifunctional ELIASA showed that 150 μl DSPE-PEG (2000)Amine (100 μm) solution per 200 μl microbubbles suspension was the optimal proportion, with the peak carry efficiency as (83.41±2.21)%. Conclusions The amination of commercially available SonoVue is realized by the insertion of DSPE-PEG (2000) Amine molecule. Glutaraldehyde crosslinking the liposomes and microbubbles is feasible. Moreover, we can choose other active groups to modify the microbubbles and liposomes, construct more convenient methods with higher efficiency.
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Objective To compare the efficacy of transrectal ultrasonography(TRUS)and spiral computed tomography(SCT)in preoperative staging of rectal carcinoma contrasted with the postoperative pathologic findings.Methods Both TRUS and SCT were performed prior to surgery in 92 patients with rectal carcinoma.After radical operation,the preoperative findings were compared with the histological findings,and the the efficacy of TRUS and SCT in staging the rectal carcinoma were evaluated.Results The accuracy of TRUS for T stage and N stage was 87.0% and 64.1% respectively,while the accuracy of SCT was 68.5% and 66.3%.Conclusions TRUS is superior to SCT for the judgment of tumor infiltration depth,TRUS may become the first choice in preoperative staging of rectal carcinoma.But neither is able to provide satisfaction assessment for lymph node metastases.When both methods are used together,it would be better.
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Objective To investigate the methods and evaluate their efficacy of pseudoaneurysms by color Doppler ultrasound guided compression and injection treatment.Methods Twenty patients with seventeen femoral artery pseudoaneurysms and three subclavian artery pseudoaneurysms underwent compression and injection treatment with color Doppler ultrasound guided.Results Simple compression method presented a successful rate of 86%(12 out of 14 patients).Two with subclavian artery pseudoaneurysms were injected with medical OB glue,as a result,one had a hard knot in the lesion after treatment,the other was thrombosed in the remote artery.Thrombin injection achieved the rate of success 100%, 4 in 4 patients.Conclusions Color Doppler ultrasound guided compression and thrombin injection is a simple,safe and effective method for the treatment of postangiographic pseudoaneurysms,but medical OB glue injection may bring about complications.