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Objective:To investigate the clinical value of contrast-enhanced ultrasonography in the diagnosis of inflammatory hepatocellular adenoma.Methods:100 patients with inflammatory hepatocellular adenoma who received treatment in the Department of Oncology, Zhejiang Quhua Hospital, between March 2018 and March 2021, were included in this study. These patients were divided into < 5 cm group (control group, n = 65) and ≥ 5 cm group (observation group, n = 35) according to maximum tumor diameter. Routine ultrasonography and contrast-enhanced ultrasonography findings were compared between the two groups. Results:Pathological findings and immunohistochemical staining results confirmed all patients had inflammatory hepatocellular adenoma. There were 65 patients with maximum tumor diameter < 5 cm in the control group and 35 patients with maximum tumor diameter ≥ 5 cm in the observation group. Routine ultrasonography findings revealed there were no significant differences in internal echo, border, shape, and blood flow distribution between control and observation groups ( χ2 = 0.45, 0.08, 3.12, 3.54, all P > 0.05). In the control group, 56 (86.15%) patients had a uniform echo and 9 (13.85%) patients had an uneven echo. In the observation group, 19 (54.29%) patients had a uniform echo and 16 (45.71%) patients had an uneven echo. There were significant differences in the number of patients having a uniform echo or an uneven echo between the two groups ( χ2 = 12.32, P < 0.05). There were no significant differences in contrast-enhanced ultrasonography results in terms of arterial phase enhancement mode, portal phase enhancement performance, delayed phase enhancement performance, and presence of a vessel sign under the capsule between the two groups ( χ2 = 0.65, 0.40, 1.75, 2.07, all P > 0.05). In the control group, 55 (84.62%) patients had a uniformly contrast-enhanced area, and 10 (15.38%) patients had a non-uniformly contrast-enhanced area, in the arterial phase at the peak intensity. In the observation group, 16 (45.71%) patients had a uniformly contrast-enhanced area, and 19 (54.29%) patients had a non-uniformly contrast-enhanced area, in the arterial phase at the peak intensity. There was a significant difference between the two groups ( χ2 = 16.52, P < 0.05). No patients from the control group had an internal perfusion defect, and 12 (34.29%) patients from the observation group had an internal perfusion defect. There was significant difference in the number of patients having an internal perfusion defect ( χ2 = 25.32, P < 0.05). High contrast enhancement in the arterial phase appeared in two groups. Conclusion:Contrast-enhanced ultrasonography can display the imaging features of inflammatory hepatocellular adenoma, which reflects the hemodynamic differences among foci of different sizes and helps diagnose and treat inflammatory hepatocellular adenoma.
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Objective:To evaluate the efficacy of bedside gastric ultrasound in guiding enteral nutrition therapy in the patients with spontaneous cerebral hemorrhage.Methods:Sixty-one patients with spontaneous intracerebral hemorrhage in the intensive care unit (ICU) of our hospital, aged 18-60 yr, with the European malnutrition risk screening score in 2002 was ≥ 3, who could not eat orally, were selected.All patients received decompression or aneurysm clipping under general anesthesia.Patients were divided into 2 groups using a random number table method: control group ( n=30) and ultrasound group ( n=31). Nutrient infusion pump was used to infuse standard whole protein formula enteral nutrition continuously through a nasogastric tube.In control group, gastric residual volume, residual traits and bowel sounds were evaluated according to gastric drainage to start or adjust enteral nutrition treatment.In ultrasound group, the antral motility index and gastric residual volume were monitored by the modified antral single section method under ultrasound to start or adjust enteral nutrition treatment.The starting time of enteral nutrition, time to reach the target feeding amount, rate of reaching the target feeding standard within 96 h, interruption of enteral nutrition, duration of hospitalization in ICU, and occurrence of intraperitoneal hypertension, aspiration, diarrhea, gastrointestinal bleeding and new pulmonary infection during enteral nutrition therapy were recorded. Results:Compared with control group, the initiation time of enteral nutrition and time to reach the target feeding amount were significantly shortened, the interruption rate of enteral nutrition was decreased, the rate of reaching the target feeding standard within 96 h was increased, the incidence of aspiration and new pulmonary infection was decreased ( P<0.05), and no significant change was found in the duration of hospitalization in ICU and incidence of intraperitoneal hypertension, diarrhea and upper gastrointestinal bleeding in ultrasound group ( P>0.05). Conclusions:Bedside gastric ultrasound-guided enteral nutrition therapy can improve the therapeutic effect with higher safety in the patients with spontaneous intracerebral hemorrhage.
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Objective:To investigate the effects of critical care chest ultrasonic examination(CCUE)on different fluid management phases among septic shock infants in pediatric intensive care unit(PICU).Methods:Twenty-two infants who were hospitalized in PICU during January 2017 to December 2018 and diagnosed as septic shock were included in this study.These infants received shock and infection management as well as mechanical ventilation according to the septic shock management guidelines.CCUE was applied as needed to monitor the hemodynamic status for titrated adjustment in fluid and vasoactive drug management and its impacts were evaluated.Results:The change frequencies of treatment regimen according to CCUE evaluation were different among different phases( P<0.001). Compared with the other 3 phases, the number of adjustment made to fluid management scheme caused by CCUE during the first phase was the largest(75.0%, P<0.001), and that during the fourth phase was the smallest(2.3%, P<0.01). The frequency of change during the second phase(30.5%) and the third phase(23.5%) showed no difference( P=0.210). During the first phase, compared with the group with intravenous infusion speed<10 mL/(kg·h), the group with faster intravenous infusion speed had lower LUS score and more proportion of LVEF and RVEF above 50%( P<0.05). During the second phase and the third phase, compared with group receiving slower intravenous infusion, group with faster intravenous infusion had more LVEF>50%( P<0.05). Conclusion:Application of CCUE to monitor dynamic hemodynamic of infants with septic shock in PICU has different effects on fluid management scheme adjustment at different phase.CCUE evaluation during the early 3 phases, especially during the first phase has greater influence on fluid management strategy.Rapid infusion under CCUE monitoring is often limited by cardiac ejection fraction, LUS, and mainly LVEF, especially during the first phase.Multiple ultrasonic indicators should be combined with clinical data for full evaluation.
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Objective@#To investigate the effects of critical care chest ultrasonic examination (CCUE) by intensive care physician on fluid management among septic shock patients in pediatric intensive care unit (PICU).@*Methods@#Forty children from PICU who were diagnosed as septic shock in Shenzhen Bao′an Maternal and Child Health Hospital were included in this study.Twenty-two of them who were hospitalized in PICU during January 2017 to December 2018, under the care of 4 PICU physicians who had certificates of the Chinese Critical Ultrasound Study Group(CCUSG) were defined as CCUE group.Eighteen PICU patients from January 2014 to December 2015 having no access to CCUE were recruited as control group.Both groups were treated according to the septic shock management guidelines with routine anti-shock and anti-infection therapy, as well as mechanical ventilation.Fluid management following conventional protocol was performed in the control group.While in the CCUE group, CCUE was applied to monitor the hemodynamic status for adjustment in fluid management.@*Results@#Compared with the control group, the CCUE group had shorter mechanical ventilation time as well as less fluid intake and output within 48 hours after admission[(4.68±2.06)d vs.(7.33±0.49)d, (6.34±1.85)ml/(kg·h) vs.(8.55±0.39) ml/(kg·h), (2.47±1.22)ml/(kg·h) vs.(6.18±1.72)ml/(kg·h)] (P<0.05). The CCUE group also had a more positive fluid balance and larger dosage of midazolam and fentanyl administration[(3.87±2.33)ml/(kg·h) vs.(2.37±2.10)ml/(kg·h), (5.62±2.39)μg/(kg·min) vs.(1.68±0.82)μg/(kg·min), (1.41±0.39)μg/(kg·h) vs.(0.95±0.56)μg/(kg·h)] (P<0.05). The two groups showed no differences in vasoactive-inotropic score within 48 h(11.11±6.08 vs.9.90±4.12), dosage of furosemide[(1.07±0.52)mg/(kg.d) vs.(0.94±0.15)mg/(kg·d)], length of PICU stay[(10.73±7.48)d vs.(10.00±2.91)d], intubation rate after 1 hour of volume resuscitation[54.5%(12/22)vs.33.33%(6/18)] or mortality[8.3%(2/24)vs.5.3%(1/19)] (P>0.05).@*Conclusion@#Application of CCUE helps to optimize fluid management and shorten the ventilation time among children with septic shock in PICU.
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Objective To investigate the diagnostic value of cranial ultrasonic examination combined with the detection of serum neuron specific enolase(NSE),S100B and interleukin-6(IL-6)on cerebral white matter lesions of premature infant. Methods Thirty-nine premature infants with cerebral white matter injury diagnosed by cranial magnetic resonance imaging (MRI)in Women and Infants Hospital of Zhengzhou City from August 2016 to July 2017 were selected as observation group. Another thirty premature infants without brain white matter injury were selected as control group in the same period. On the 1st , 3rd and 7th day after birth,the serum NSE level was detected by the automatic time resolved fluoroimmunoassay system,the lev-els of serum S100B and IL-6 were detected by double anti sandwich enzyme-linked immunosorbent assay,and the changes of the cerebral white matter echoes around the cerebral ventricles were observed by cranial ultrasonic examination. The sensitivi-ty,specificity and accuracy combined detection of cranial ultrasonic examination combined with serum NSE,S100B and IL-6 in the diagnosis of white matter lesions in premature infants were analyzed. Results The detection rate of cerebral white matter lesions by cranial ultrasonic examination in the control group was 6. 45％(2 / 31),3. 23％(1 / 31)and 0. 00％(0 / 31)respec-tively;and it was 92. 31％(36 / 39),87. 18％(34 / 39)and 84. 62％(33 / 39)respectively on the 1st ,3rd and 7th day after birth in the observation group;the detection rate of cerebral white matter lesions in the observation group was significantly higher than that in the control group on the 1st ,3rd and 7th day after birth(χ2 = 51. 30,48. 69,49. 63;P < 0. 05). There was no signifi-cant difference in the grayscale value of cerebral white matter among the 1st ,3rd and 7th day after birth in the two groups(P >0. 05). The grayscale value of cerebral white matter in the observation group was significantly higher than that in the control group on the 1st ,3rd and 7th day after birth(P < 0. 05). There was no significant difference in serum S100B and IL-6 levels a-mong the 1st ,3rd and 7th day after birth in the control group(F = 0. 319,0. 307;P > 0. 05). There was the significant difference in serum NSE level among the 1st ,3rd and 7th day after birth in the control group(F = 3. 298,P < 0. 05),the serum NSE level on the 3rd and 7th day after birth was significantly lower than that on the 1st day after birth(P < 0. 05),the serum NSE level on the 7th day after birth was significantly lower than that on the 3rd day after birth(P < 0. 05). The levels of serum NSE,S100B and IL-6 in the observation group showed the downward trend on the 1st ,3rd and 7th day after birth(F = 3. 323,3. 517,3. 706;P < 0. 05). The levels of serum NSE,S100B and IL-6 on the 3rd and 7th day after birth were significantly lower than those on the 1st day after birth in the observation group(P < 0. 05). There was no significant difference in the levels of serum NSE, S100B and IL-6 between the 3rd and 7th day after birth in the observation group(P < 0. 05). The levels of serum NSE,S100B and IL-6 in the observation group were significantly higher than those in the control group on the 1st ,3rd and 7th day after birth (P < 0. 05). In the observation group,the grayscale value of cerebral white matter was positively correlated with the levels of serum NSE,S100B and IL-6 on the 1st day after birth(r = 3. 137,3. 358,3. 056;P < 0. 05);the grayscale value of cerebral white matter was positively correlated with the levels of serum NSE and S100B on the 3rd day after birth(r = 2. 872,2. 347;P <0. 05);the grayscale value of cerebral white matter was positively correlated with serum S100B level on the 7th day after birth (r = 2. 791,P < 0. 05). The sensitivity,specificity and accuracy of combined detection of cranial ultrasonic examination and, serum NSE and S100B in the diagnosis of cerebral white matter lesions in premature infants was 100. 00％,93. 54％ and 97. 14％ respectively. Conclusion The combined detection of cranial ultrasonic examination,serum NSE and S100B can sig-nificantly improve the accuracy of early diagnosis of cerebral white matter lesions.
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Objective To discuss the function and advantages of ultrasound technology in various factors in the diagnosis of vertebral artery stenosis lesions.Methods The objective data of ultrasonography were selected in 60 patients (120 vertebral arteries) with paroxysmal,reversible vertigo and headache as the chief complaint,the internal relations were summarized and analyzed.Results In the subjects of study,the vertebral artery stenosis for 38.2％,vertebral artery course tortuosity changer accounted for 33.3％,congenital abnormal development accounted for 9.8％,mixed cause 18.6％,dominant etiology was vertebral artery sclerosis and vertebral artery tortuosity change.Conclusion Ultrasound technology has important value of clinical application in the reasons diagnosis of vertebral artery stenosis disease,it can help extend clinical diagnosis.
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Objective To investigate the correlation between the elastographic characteristics of liver and postoperative function of liver allografts.Methods Forty-eight cases of liver transplantation from The First Affiliated Hospital of Sun Yat-sen University were analyzed,Shear wave elastography (SWE) was performed before operation or at one week or one month post-operation.Liver function was evaluated by measuring alanine aminotransferase (ALT),aspartate transaminase (AST),total bilirubin (TBIL),γ-glutamine transferase (GGT),albumin (ALB),alkaline phosphatase (ALP),prothrombin time (PT),activated partial thromboplastin time (APTT),and international normalized ratio (INR).Early allograft dysfunction (EAD) was also analyzed with reference to SWE among liver transplant recipients.Results SWE at one week after transplantation was significantly correlated with TBIL (r=0.525 6,P<0.01),APTT (r=0.668 3,P<0.000 1),PT (r=0.593 7,P=0.000 1),INR (r=0.609 6,P<0.000 1) and prealbumin (r=-0.464 1,P<0.01).However,no significant correlation was observed between pre-operative SWE and parameters of post-operative liver function.SWE in EAD patients was higher than that of patients without EAD (17.60±1.09 kPa vs.13.38±0.99 kPa,P<0.01).The optimal cut-off value of SWE at one week post-operation was 14.85 kPa.Conclusion Postoperative SWE is significantly correlated with postoperative liver function tests and EAD,suggesting SWE is a potential test for evaluating the quality of liver allografts.
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Objective:To investigate the analysis of features and differential diagnosis of ultrasonic image for patient with endometrial lesions.Methods: The imaging data of 80 patients with endometrial lesions were selected as random number table. The relevant ultrasound manifestations and sonographic features of patients were further analyzed, and then these data were compared with the pathological diagnosis by using operation.Results: In the 80 patients with endometrial lesions, 43 cases were endometrial polyps, and in the 43 cases, there were 41 cases were consistent with the pathological diagnosis and the diagnostic accordance rate was 95.35%, while there were 2 cases were not consistent between the two methods. 33 cases of the 80 patients were submucous myoma of uterus, and there were 29 cases of them were consistent with the pathological diagnosis and the diagnostic accordance rate was 87.88%, while there were 4 cases were not inconformity. And 4 cases of the 80 patients were endometrial carcinoma, the result was completely consistent with the pathological diagnosis and the diagnostic accordance rate was 100%. In the 6 misdiagnose cases, the ratios of atypical cases and (or) typical cases were 1:16, 5:36 and 1:8, respectively. All of these endometrial lesions has the distinctive manifestations on the ultrasonoscopy of color Doppler.Conclusion: For the detection of endometrial lesions, transvaginal colar Doppler ultrasonic detection has unique feature of ultrasonogram compared with other detection methods. In the contrast, there is a regular congruent relationship between the ultrasonogram of typical disease and section of pathological specimen by using operation in a certain degree, and the ultrasonogram of typical disease has definite diagnosis value.
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Objective To compare the value of shear wave elastography (SWE)and mammography in differential diagnosis of benign and malignant breast neoplasms.Methods Totally 96 patients with breast tumor were randomly chosen and underwent SWE andmammography.The elastic maximum value (Emax)was obtained. Taking histological diagnosis as the golden standards,we compared the two techniques' sensitivity,specificity, accuracy,positive and negative predictive value in diagnosis of breast tumors.Results The sensitivity,specificity, accuracy,positive and negative predictive value of Emax were 91.3%,94.0%,92.7%,93.3% and 92.1%, respectively.The sensitivity and accuracy of E-max were significantly better than those of x-ray (both P <0.05 ). The area under the ROC curve of Emax was 0.983 (95% CI,0.963 to 0.998).Conclusion SWE outperforms mammography in differential diagnosis of benign and malignant breast tumors.
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Objective To compare the value of shear wave elastography (SWE)and mammography in differential diagnosis of benign and malignant breast neoplasms.Methods Totally 96 patients with breast tumor were randomly chosen and underwent SWE andmammography.The elastic maximum value (Emax)was obtained. Taking histological diagnosis as the golden standards,we compared the two techniques' sensitivity,specificity, accuracy,positive and negative predictive value in diagnosis of breast tumors.Results The sensitivity,specificity, accuracy,positive and negative predictive value of Emax were 91.3%,94.0%,92.7%,93.3% and 92.1%, respectively.The sensitivity and accuracy of E-max were significantly better than those of x-ray (both P <0.05 ). The area under the ROC curve of Emax was 0.983 (95% CI,0.963 to 0.998).Conclusion SWE outperforms mammography in differential diagnosis of benign and malignant breast tumors.
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Objective:To investigate the Value of Wavelet Analysis to Ultrasonic Diagnosis for liver neoplasms. Methods: The tissue images of Liver Neoplasms by ultrasonic examination experienced color conversion with Photoshop software, and the corresponding relationship among wavelet coefficient, spacial distribution and local image characteristic after conversion were analyzed, i.e.the row details were arrayed in line sequence,the line details in row sequence and the diagonal details in Zsequence. Results: The frequency spectral data and the image texture information were provided via imaging detection and wavelet analysis of, as well as the quantitative data description of the texture of the foci or the normal tissue. Conclusion:Wavelet analysis provided with a reliable basis for the early clinical diagnosis and treatment for liver neoplasms, by which the focal character and degree can be differentiated or analyzed.
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Objective To investigate the clinical significance of ultrasonography in the diagnosis of simple polyhydramnios . Methods 186 singleton pregnancies cases of inpatient and outpatient diagnosed with simple polyhydramnios were divided into three groups with a two-dimensional semi-quantitative method ,separate amniotic fluid index (AFI)> 20cm (A group) ,separate maxi-mum amnionic fluid volume(AFV)>8 cm(B group) ,AFI≥20 cm and AFV≥8 cm(C group) ,and the changes were dynamically monitored .Results Occurrence rates of persistent polyhydramnios and fetal malformations in C group was higher than in the other two groups ,and the difference showed no statistical significance(P0 .05);Among the 84 .4% of simple polyhydramnios ,no fetal malfor-mation was found .Conclusion Ultrasound diagnosis of simple polyhydramnios shows clinical value in assessment of fetal malfor-mation ,fetal outcome ,perinatal morbidity and prognosis ,and is good for prenatal counseling and treatment .
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Objective To explore the value of oral ultrasonic contrast agent on preoperative T staging of gastric cancer.Methods 62 patients diagnosed with gastric neoplasms by operation and pathology were analyzed retrospectively.Patients were treated by oral ultrasonic contrast agent and conventional ultrasonography before surgery,two methods were compared with postoperative pathology.Results Oral ultrasonic contrast agent and conventional ultrasound detection rates of gastric neoplasms were 100.0 ％(62/62)and 64.5 ％ (40/62),The difference was significant between the two examination methods(x2 =24.369,P ＜ 0.05).The oral ultrasonic contrast agent and conventional ultrasound with T1,T4 staging accuracy rates were 85.7 ％(6/7),0,92.3 ％(36/39),59.0 ％(23/39),there were significant differences(both P ＜ 0.05).T2,T3 staging accuracy rate were 75.0 ％(3/4),0,83.3 ％(5/6),33.3 ％(2/6),the differences were not significant(P =0.143,P =0.242).Conclusion Oral ultrasonic contrast agent in preoperative T staging diagnosis has higher accuracy rate in gastric neoplasms,it could guide clinical rational therapy.It is worth promoting non-invasive,convenient means of stomach diseases census.
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Objective To investigate the value of ultrasound locates the appendectomy and guide appendec -tomy incision in small incision appendectomy .Methods According to the digital table ,80 patients with acute appen-dicitis diagnosed by B ultrasound examination , were randomly divided into the observation group , and the control group.Each of the group has 40 cases and use small incision appendectomy .In the observation group , mark corre-sponding appendix root in the abdominal wall surface when use B ultrasound examination ,and mark again in anesthe-sia before surgery.Design of a 2~2.5cm minimal incision according to appendix after anesthesia marker ,distance measurement before and after .The control group did not use B ultrasound localization ,minimal incision by McBurney point or near tenderness point .Between the two groups in operation time ,bleeding volume ,postoperative exhaust time , hospitalization time,complications.Results Ultrasound before and after positioning distance was (1.9 ±0.6)cm,and the preoperative immediate ultrasound localization of appendix and intraoperative exploration results ,and preoperative ultrasound localization in observation group ,the average operation time was better than no ultrasound localization of group(P<0.05).The amount of bleeding volume,postoperative exhaust time,hospitalization time,complications had no obvious difference .Conclusion Preoperative immediate ultrasound can more accurately reflect the position of ap-pendix ,favorable operation in small incision appendectomy is quickly ,shorten the operation time .