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Objective:To summarize the ultrasound manifestations of lung lesions in patients with coronavirus disease 2019 (COVID-19), and explore the clinical value of ultrasonography in assessing the severity of the disease.Methods:Thirty-one patients with COVID-19 admitted to the Fifth Affiliated Hospital of Sun Yat-sen University from January 18 to February 5, 2020, were selected as the research subjects. All of them underwent dynamic lung ultrasound. Their lung lesions were observed, and the lung ultrasound score (LUS) was performed, respectively. The correlations between the LUS and the disease classification, the LUS and the blood oxygenation index (PaO 2/FiO 2) were analyzed, respectively. The relationship between the corresponding change of clinical classification and the LUS score when it progressed to moderate/severe was analyzed as well. Results:Among the 31 patients with COVID-19, two (6.5%) had no apparent lesions at the ultrasound, with the LUS score of 0. Twenty-nine (93.5%) showed abnormities at the ultrasound, with the LUS score from 1-26, and the main manifestations were B-line signs. Among them 6 (19.4%) had the "white lung signs" , and 13 (41.9%) had pulmonary consolidations. The LUS score was positively correlated with the clinical classification ( r s=0.683 2, P<0.001) and negatively correlated with PaO 2/FiO 2 ( r=-0.864 3, P<0.001). In the initial and dynamic ultrasonography, 13 patients were graded as moderate/severe according to their LUS scores, and the accuracy of the LUS in assessing severe/critical patients was 81.3% (13/16). It was 1-3 days earlier for the LUS progressing to moderate/severe than clinical classification. Conclusions:Pulmonary ultrasound manifestations of patients with COVID-19 have specific characteristics mainly showing as lung interstitial lesions, which can be combined with pulmonary consolidation. Ultrasound can be used in the assessment of the severity of COVID-19 noninvasively and guide clinical treatment.
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Objective To investigate the feasibility and accuracy of three-dimensional ultrasound-ultrasound(3DUS-US)fusion imaging based on electromagnetic positioning in the assessment of ablation zone of liver tumor through experimental study in phantom models.Methods Sixteen phantom models which could be ablated and used to assess the ablation zone were established.Then,they were ablated and divided into complete ablation group(n =8)and incomplete ablation group(n =8)randomly.Their ablation effects were assessed by 3DUS-US fusion imaging.If the tumor model was assessed as incomplete ablation,the maximum thickness of the residual tumor was measured.The assessments of gross specimen were used as golden standard to validate the feasibility and accuracy of assessment of 3DUS-US fusion imaging.The success rate of registration,duration time of fusion imaging,accuracy rate of assessment and measurement error in incomplete ablation group were recorded.Results All of the 16 phantom models were produced successfully.The success rate of registration was 100% and the duration time of 3DUS-US fusion imaging was(3.9±1.0)min.The accuracy rate of assessment was 100%.There was no significant difference between the assessment of residual tumor thickness in incomplete ablation group by 3DUS-US fusion imaging and gross specimen(t=-0.814,P =0.442),and the measurement error was(1.1±0.6) mm.Conclusions 3DUS-US fusion imaging based on electromagnetic positioning is a feasible,accurate and convenient method in the assessment of ablation zone of liver tumor.It would be a new immediate precise assessment method during ablation procedure for liver tumor.
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Objective To evaluate the feasibility,efficacy and tolerability of ultrasound-guided percutaneous radiofrequency ablation(RFA) for treating malignant tumor in the caudate lobe.Methods A retrospective analysis was performed in the patients with malignant tumor in the caudate lobe treated by percutaneous radiofrequency ablation (RFA) from January 2009 to July 2016.The epigastric approach (EA),the intercostal approach (IA) and an approach combining EA and IA were used as the paths of puncture.Intraprocedural contrast enhanced ultrasound (CEUS) was used to evaluate the ablation effect.The enhancement of CT/MR was used as the gold standard to evaluate the ablation effect within 1 to 3 months after surgery.Technical success (TS),technique efficacy (TE),local tumor progression (LTP) and complications were documented.Results A total of 14 patients with 14 malignant tumors in the caudate lobe of the liver were included in this study.The EA,IA,and the approach combining EA and IA were used in 7,6,and 1 patient,respectively.Intraprocedural CEUS showed complete ablation in all cases.CT / MRI evaluation within 1 to 3 months after surgery showed that the complete ablation rate was 100％ (14/14).After a median follow-up of 15.5 months (interquartile range,3 55 months),2 patients had recurrence in other regions of the liver,there was no local tumor progression and no serious complications occurred in 14 patients.Conclusions Ultrasound guided RFA is a safe,effective and important mean for the treatment of malignant tumors in caudate lobe of liver.
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Objective To evaluate the feasibility and efficacy of mono-modality fusion imaging using ultrasound in the intraoperative immediate evaluation of therapeutic response of liver cancer thermal ablation.Methods A total of 70 liver cancers in 53 patients that underwent thermal ablation from October to November 2015 were included in this study.Mono-modality fusion imaging using ultrasound was applied immediately after the ablation procedure to evaluate the therapeutic response of the thermal ablation.The applicable rate,the success rate of registration,the duration time,the evaluation results and the rate of supplemental ablation were recorded.Ultrasound examination was performed on the first day after ablation to evaluate the early complication.Contrast-enhanced CT/MR within 1-3 months after the procedure was regarded as the golden criteria of the treatment response.In the follow-up period,the rate of local tumor recurrence,progression-free survival and overall survival were analyzed.Results The applicable rate for mono-modality ultrasound fusion imaging is 62.9％ (44/70) while the success rate of registration is 90.9％ (40/44).The duration time for mono-modality is 2.7-7.5 min,with an average of (3.9 ± 0.9) min.Thirty-seven out of 40 liver cancers were evaluated to achieve safety margin and 3 out of 40 were not.The rate of supplemental ablation was 40％ (16/40).The rate of complete ablation was 97.3％ (36/37) according to contrast-enhanced CT/MR within 1-3 months.In the follow-up period,no local tumor recurrence was observed and the rates of intra-hepatic recurrence and overall survival were 46.7％ (14/30) and 96.7％ (29/30),respectively.Conclusions Mono-modality ultrasound fusion imaging is a convenient,feasible,safe and efficient method in the intraoperative immediate evaluation of therapeutic response of liver cancer thermal ablation.
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[Objective]To compare the clinical application value of fusion imaging of ultrasound(US)and computed tomogra-phy(CT)or magnetic resonance(MR)(US-CT/MR fusion imaging)and fusion imaging of US and three-dimensional US(US-US fusion imaging)in treatment response assessment of thermal ablation combined with other surgeries and procedures.[Methods]This clinical research included patients confirmed with liver cancers that underwent thermal ablation combined with other surgeries and procedures from Aug to Dec 2015. Both US-CT/MR and US-US fusion imaging together with contrast-enhanced US was applied on the same patient to assess the treatment response of the thermal ablation during the ablation procedure. The applicable rate ,the success rate of registration and the duration required for fusion imaging were recorded and compared. Contrast-enhanced CT/MR 1-3 months after the ablation procedure was taken as the golden reference of the technical efficacy rate for ablation.[Results]67 liver can-cers in 50 patients were enrolled in this clinical research in total. The ablation of 47 lesions in 37 patients were combined with artifi-cial hydrothorax or ascites ,14 lesions in 10 patients with open surgeries and 8 lesions in 5 patients with laparoscopy surgeries. The applicable rate for US-US fusion imaging[52.5%(35/67)]was lower than that for US-CT/MR fusion imaging[98.7%(66/67)](P<0.001)while the success rate of registration for US-US fusion imaging[88.6%(31/35)]was higher than that for US-CT/MR[66.7%(44/66)](P=0.018). The duration time for US-US fusion imaging[3.8 min(2.7~10.0 min)]was significantly shorter than that for US-CT/MR fusion imaging[5.5 min(3.0 ~ 14.0 min)](P < 0.001). No major complication related to ablation was observed. The technical efficacy rate for ablation was 100%(62/62)according to the contrast-enhanced CT/MR 1-3 months after the ablation proce-dure.[Conclusion]For ablation combined with other surgeries and procedures ,US-US fusion imaging should be priority when the tumor is conspicuous in US,especially for cases combined with open surgeries while US-CT/MR fusion imaging should be selected in some cases when the tumor is inconspicuous on US.
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Objective To discusse the feasibility and application value of the computer-assisted liver cancer ablation planning based on the three dimensional ultrasound.Methods Forty three-dimensional ultrasound images of 39 patients with 40 tumors'maximum diameter between 21 to 70 mm were collected and then acquired image segmentation and visualzation.The computer-assisted liver cancer ablation planning based on three dimensional ultrasound was comparied with the artificial ablation planning based on two dimensional ultrasound to find out the differences in the success rate,damage rate,time-consuming and the number of insertions between these two methods.Results Compared with the artificial ablation planning based on two dimensional ultrasound,the computer-assisted liver cancer ablation planning had a higher success rate(92.31% vs 53.85%,P =0.000),lower damage rate(7.50% vs 25.00%,P =0.034),shorter time-consuming(44.0 s vs 263.0 s,P =0.000)and less insersion times(3 vs 4,P =0.009).Conclusions The computer-assisted liver cancer ablation planning based on three dimensional ultrasound is more efficient and safety than the traditional way.
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Objective To evaluate the clinical value of CT/MR-contrast enhanced ultrasound (CEUS) image fusion in immediate assessment for hepatocellular carcinoma (HCC)ablation.Methods Patients diagnosed with HCC to receive ablation therapy were randomly divided into two groups.The ablation for each patient was performed according to their pre-ablation plan.Immediate assessments for the ablation were performed using CT/MR-CEUS image fusion (IF group)and CEUS (CEUS group)separately and whether the need for additional ablations was decided and performed during the therapy.The therapy efficacy was evaluated with enhanced CT or MR 1 month after each complete ablation treatment.Results There were 101 patients with 131 nodules in IF group,and 15.1% of the nodules needed additional ablation according the immediate assessment during the therapy.The complete ablation rate of IF group was 99.2%(125/126).On the other hand,there were 93 patients with 122 nodules in CEUS group,and 4.2% of the nodules needed additional ablation according the immediate assessment during the therapy.The complete ablation rate of CEUS group was 94.2% (113/120).IF group has significantly higher additional ablation rate and complete ablation rate than CEUS group (P <0.05).Conclusions CT/MR-CEUS image fusion can further improve ablation efficacy with accurate intraoperative evaluation and guidance of additional ablation compared with CEUS.
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Objective To evaluate the feasibility and accuracy of three-dimensional ultrasound-ultrasound (3DUS-US)automatic image fusion technology based on electromagnetic positioning.Methods The experimental phantom was constructed to acquire ultrasonic images by agarose gel and additives,which was used as the experimental object.3DUS imaging with free-hand and real-time ultrasound imaging automatic registrations were performed based on electromagnetic positioning.To investigate the effect of 3DUS-US image fusion under different scanning speed by free-hand,the fast and slow groups were designed. In addition,a junior operator and a senior operator performed 3DUS-US automatic registrations,and recorded the operating time and registration error,respectively.The repeatability between two operators was analyzed.Results The macroscopic appearance,stability and ultrasonic image of the phantom met the demand of this research.The success rate of 3DUS-US automatic image fusion technology was 100%(40/40).The slow group's registration error distance was (1 .44 ± 0.64)mm,which was obviously lower than the fast group's (2.56±0.53)mm,the difference was statistically significant (P <0.001).There were no statistically differences of the registration error and operating time between the two operators (P =0.508,P = 0.5 1 7 ).Conclusions The technology of 3DUS-US automatic registration based on electromagnetic positioning was feasible and accurate,which is worth applying into the clinical treatment.
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Objective To compare the accuracy,convenience and repeatability of 3DUS-US and CT-US image fusion technology based on electromagnetic positioning.Methods A tissue-mimicking phantom was established and used to obtain ultrasound or CT volume images.Two different operators performed 3DUS-US and CT-US image fusion and repeated 10 times,respectively.The success rate,the registration error distance and fusion time of two techniques were recorded and compared between the different operators.Results The ultrasound and CT images of the phantom and its stability could meet the demands of this experiment.3DUS-US and CT-US image fusions were successful.The registration error distance of 3DUS-US image fusion was (1 .70 ± 0.42)mm and fusion time was (76.00 ± 9.99)s,they were obviously superior to CT-US (P = 0.014,P < 0.001 ).There were no significant differences between the two operators in the registration error distance and fusion time of 3DUS-US (P =0.508,P =0.5 1 7).But the registration error distance of CT-US image fusion in experienced operator was lower than the junior (P =0.009),and fusion time had not statistical difference between the two operators (P =0.234).Conclusions The technique of 3DUS-US automatic image fusion based on electromagnetic positioning has advantages of convenience and no experiential dependence comparing with CT-US in the phantom experiments,so it is worthy of being widely popularized in clinical application.
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Objective To evaluate the feasibility and accuracy of three-dimensional ultrasound (3DUS) automatic image fusion based on hepatic vessel in clinical application.Methods Forty pairs of 3D ultrasound volumetric images from 10 healthy volunteers were acquired and enrolled in the study,including 10 pairs of each following lobe of the liver:left lateral lobe,left medial lobe,right anterior lobe and right posterior lobe.3DUS automatic registrations were performed based on hepatic vessel.The technical successful rate and accuracy of the image fusion using the 3DUS data from four hepatic lobes were observed and compared.Results Thirty-six pairs of volumetric data were successfully fused together by automatic registration.The technical successful rate was 90％ (36/40) and the registration error distance was 1.48 mm (0.98-2.76 mm).There were no statistical differences in the successful rate for the four different hepatic lobes (P =0.891),but the registration error of right anterior lobe was less than left lateral lobe of liver (P =0.014).Conclusions The new technology of 3DUS automatic registration based on hepatic vessel was feasible and reliable,and it has a wide prospect in future clinical application.
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Objective To select early prediction indexes related to the prognosis of severe hepatitis in ultrasonography,and evaluate its clinical value.Methods Clinical data of 269 cases of severe hepatitis patients was analyzed retrospectively.Cox proportional hazards regression model was adopted to analyze 13 possible prediction ultrasonic parameters for severe hepatitis,including thickness of the right hepatic lobe,portal vein (PV) diameter,volume of ascites,etc.After selected from these parameters,the clinical value of early prediction factor was evaluated with ROC curve.Results Multivariate analysis showed that thickness of the right hepatic lobe,portal vein (PV) diameter,opening of paraumbilical vein and bile viscosity were related to the death of severe hepatitis patients (P ＜ 0.05).The thickness of the right hepatic lobe contributed most (Wald =40.479),its sensitivity and specificity for prediction were 93.4％,82.8％ respectively(P ＜ 0.01).Conclusions Thickness of the right hepatic lobe,PV diameter,opening paraumbilical vein and bile viscosity are early prediction factors for severe hepatitis,need to be monitored in treatment,especially for thickness of the right hepatic lobe.
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Objective To analyze the reasons of focal liver lesions that difficult to detect by conventional ultrasound ultrasound-CT/MR fusion imaging.Methods 101 lesions which were confirmed by pathology or clinical diagnosis standards were recruited in the research.All of them were difficult to detect by conventional ultrasound but CT/MR display clearly.Ultrasound-CT/MR fusion imaging was used to observe the size,location and internal echo of the lesions,as well as the background of the surrounding liver parenchyma.Results All cases were successfully registrated,the registration time were 2-6min [(4.1 ±0.6)min].For these 101 lesions,93.1％(94/101) of which the diameter ≤20 mm,56.4％ (57/101) were located in hepatic segments near the diaphragm (such as S2,S4,S7,S8),78.2％ (79/101) were internal isoecho,and 79.2％(80/101) in the background of liver cirrhosis.Conclusions The important reasons that focal liver lesions detected difficult by conventional ultrasound includes:lesion size,location,internal echo and the hepatic background.
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Objective To analyze the double contrast-enhanced ultrasonography (DCUS) features of periamupullary carcinoma for enhancing the ultrasound diagnostic value of the disease.Methods The DCUS and clinical data of 40 patients with periampullary carcinoma confirmed by histopathology were reviewed.Results (1) The displaying rate of the lesions and the judgment of lesion location was statistically higher on DCUS than that of ordinary ultrasound (P ＜ 0.05).(2) DCUS features of periampullary carcinoma:the size of most lesions was less than 30 mm except for 1 case in which no lesion was found; In 100％ (39/39) of the lesions,the morphology did not change with duodenum movement ; In 64.1％ (25/39) of lesions hyperenhancement or isoenhancement was displayed in the arterial phase,with low enhancement in the venous phase; In 87.2％ (34/39) of lesions homogeneous enhancement was displayed; In 95％ (38/40) the bile ducts were moderately or severely dilated.The lesion locations and whether the lesions projected into the duodenal cavity or not were statistically different between the three different types of periampullary carcinoma (P ＜ 0.05).The lesions projected into the duodenal cavity of duodenum were more commonly seen in papillary carcinoma and ampullary carcinoma than distal common bile duct carcinoma.The lesion size,whether the lesion morphology changed or not with duodenum movement,enhancement level,enhancement homogeneity,the degree of bile duct dilatation,whether there was pancreatic duct dilatation or not were not statistically different between the three different types of periampullay carcinoma (P ＞ 0.05).Conclusions DCUS is an effective way to show periampullay carcinoma,and is helpful to diagnose periampullary carcinoma and distinguish the three different types of periampullary carcinoma.
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Objective To evaluate the clinical value of artificial pleural effusion for percutaneous microwave ablation of liver cancer in the hepatic dome. Methods 28 difficult cases (total 34 lesions), all lesions were located in the hepatic dome and covered by lung. Infused with artificial pleural effusion by ultrasound real-time monitoring before percutaneous ultrasound-guided microwave ablation. The amount of artificial pleural effusion, the technique successful rate,the rate of lesions revealed, local treatment response and complications had been observed. Results The amount of artificial pleural effusionwas 200-1 000 mL [(388 ± 107)mL]. The technique successul rate of artificial pleural effusion was 100% (28 / 28), the rate of lesions revealed was 85.3%(29 / 34), the other 5 isoechoic lesions were revealed by contrast-enhanced ultrasound. All the 34 lesions was ablated completely, the complete ablation rate was 100%(34 / 34). the rate of complications was 2.9%(1 / 34), 1 patient was found a small amount of intraperitoneal hemorrhage after ablation. Conclusions Artificial pleural effusion assisted percutaneous microwave ablation of liver cancer in the hepatic dome is a safe , effective treatment, it broadened the percutaneous microwave ablation therapeutic range, and should be more widely used in clinically.
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Objective To design and construct a hepatocellular carcinoma(HCC) phantom,and assess the accuracy of three dimensional ultrasound (3DUS)-CT image fusion in evaluating ablative margin (AM).Methods The phantom was constructed by carrageenan gel and additives.A sphere-shaped HCC model surrounded by a 5 mm layer of AM model was embedded into a cylindrical-shaped ground substance model to form the phantom.After radiofrequency ablation (RFA),HCC model in the phantom was ablated into ablative lesion model.The ultrasound and CT image,macroscopic appearance and stability of the phantom were observed.Twenty-four phantoms were made and ablated into different ablative lesion models in which AM was achieved or not achieved.Outline the HCC and 5mm AM in the 3DCT image and fuse 3DCT image with the 3DUS image of the ablative lesion model to see whether the ablative area could cover the AM,as well as in which quadrant complete ablation of the AM had not been achieved and the maximal thickness of the unachieved AM.The result of the 3DUS-CT image fusion was compared with gross specimen.Results The ultrasound and CT image,macroscopic appearance and stability of the phantom met the demand of this study.The sensitivity,specificity and accuracy of 3DUS-CT image fusion were 93.8％,85.7％ and 91.3％respectively.The quadrant in which complete ablation of AM was not achieved matched with gross specimen.The maximal thickness of the unachieved AM measured by 3DUS-CT image fusion and gross specimen were (3.5 ± 2.0) mm and (3.2 ± 2.0) mm respectively,and no statistic difference was found between the two results.Conclusions The phantom made of carrageenan gel and additives was suitable for the evaluation of AM.3DUS-CT image fusion evaluation of AM was accurate.
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ObjectiveTo explore the feasibility of measurement of hepatic elastic modulus using shear wave elastography (SWE).Methods Hepatic elastic modulus of 95 health control people,70 liver fibrosis patients and 86 liver cirrhosis patients were measured by SWE.ResultsThe success rate of imaging of health control people and liver cirrhosis patients were 100％,the success rate of liver fibrosis patients was a little lower,but there was no significant difference between control people and liver cirrhosis patients or fibrosis patients and liver cirrhosis patients (P ＞ 0.05 ).The modulus of elasticity had a significant difference in health control people,liver fibrosis patients and liver cirrhosis patients (P ＜0.05).The multiple parameter comparison of mean of three groups also showed a significant difference( P ＜0.05).The health control people had the lowest modulus of elasticity,the liver cirrhosis patients had the highest modulus of elasticity,there was an obvious upward trend.Conclusions SWE can be applied to the measurement of hepatic stiffness,it can better distinguish above three groups.
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Objective To demonstrate the feasibility and accuracy of the intellectual position(IP)technique used in ultrasound-guided biopsy.Methods Several red spheres,which were 10 mm in diameter and visible in ultrasound,randomly placed in the tissue mimicking gel phantom.The biopsy was performed by two operators respectively.Each operator chose 25 spheres,each of which were performed biopsy guided by IP technique,free-hand ultrasound and ultrasound with guide bracket.The red dye in the biopsied sample meant successful performance.The time spend in per biopsy target,the success rate of biopsy and the length of the red dyed sample of the three methods were recorded,and comparison was made among them.Results The median time took in biopsy guided by IP technique was 95(rang,80-110)s,which was longer than that of free-hand ultrasound-guide[30 (rang,22-42) s,P ＜0.001] and ultrasound-guide with bracket [20(rang,15-28)s,P ＜0.001].The success rate of biopsy guided by IP technique was 98.0％ (49/50)which was as well as that guided by ultrasound-guide with bracket(96.0％,48/50,P =0.558),better than free-hand ultrasound-guide(78.0％,39/50,P =0.002).The median length of red dyed sample biopsied guided by IP technique was 8.0 (rang,7.0-8.5)mm,which was longer than that of free-hand ultrasoundguide[6.0(rang,4.0-8.0)mm,P =0.003] and ultrasound-guide with bracket[7.0(rang,6.0-8.0)mm,P =0.003].There was no statistically difference between the two operators in length of red dyed sample and success rate of biopsy guided by IP technique(P ＞0.05).Conclusions Biopsy guided by IP technique is a feasible and accuracy method,which will become an effectively supplement of the ultrasound-guide with bracket.
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Objective To investigate the value of intra-cavitary contrast enhanced ultrasound(CEUS)in the location of drainage tubes which were unclear in conventional ultrasonography. Methods The locations of 32 drainage tubes in 26 patients were unclear in conventional ultrasonography. The diluted ultrasound contrast agent (SonoVue) was injected through the tubes. CEUS was used to evaluate the visualizations of the inner tubular portions and the distal ends. Whether the drainage tubes were in situ or not was also judged. The time-consumption of detection was counted. Results The percentages of the visualization of inner tubular portions and the distal ends in conventional ultrasonography were 52.25%(18/32) and 0,respectively. However,the percentages of visualization in CEUS were 100% and 93.75%(30/32), respectively. The difference were significant when compared conventional ultrasonography with CEUS ( P＜0.001 ). CEUS detected that three drainage tubes weren't in situ. And the median of timeconsumption of CEUS was just 4. 5 seconds (range: 1-77 seconds). Conclusions Intra-cavitary CEUS is a sensitive and high efficient technique in the visualization of drainage tube which may complement the insufficiency of conventional ultrasonography. It could be used as the first choice in the location of drainage tube.
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Objective To investigate the role of intra-operative and percutaneous three-dimensional contrast-enhanced ultrasonic cholangiography (3D-CEUSC) in the diagnosis of biliary anomalies. Methods Diluted SonoVue, an ultrasonic contrast agent, was injected into the cystic duct of 13 living liver donors via a cannula for intra-operative 3D-CEUSC, while injection via a T tube or a PTCD tube were done in 14 patients for percutaneous 3D-CEUSC. The maximum branching order of the intra-hepatic bile ducts, the percentages of display of the first-, second-, and third-order intra-hepatic bile ducts, and the rates of detection of biliary anatomical anomalies were evaluated. Results The median of the maximum branching order of the intra-hepatic bile ducts shown was fourth-order on intraoperative 3D-CEUSC and third-order on percutaneous 3D-CEUSC, respectively. The difference was significant (P=0.01). From the first- to the third-order of intra-hepatic bile ducts, the percentages of display for intra-operative 3D-CEUSC were 100% (23/23), 96.2% (50/52) and 82.7% (86/104),respectively, while they were 100% (24/24), 94.6% (54/56) and 60. 7% (68/112) for percutaneous 3D-CEUSC. The differences were not significant when comparing the first- and the second-order branches of intra-hepatic bile ducts as shown either on intra-operative or percutaneous 3D-CEUSC (P=1).The percentages of display of the third-order branches using intra-operative 3D-CEUSC was higher than that of percutaneous 3D-CEUSC (P＜0. 0001). Three biliary anatomical anomalies were detected by intra-operative 3D-CEUSC and 4 anomalies were detected by percutaneous 3D-CEUSC. All of these anomalies were confirmed by X-ray cholangiography. Conclusion Both intra-operative and percutaneous 3D-CEUSC could diagnose biliary anatomical anomalies accurately. These procedures may become important techniques to evaluate the biliary anatomy in hepatobiliary surgery pre-operatively or intraoperatively.
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ObjectiveTo verify the feasibility and the accuracy for the biopsy of targets not visible on sonography but shown on CT in a phantom by using real-time virtual navigation system(RVS).Methods The tissue mimicking phantom,made of gel,contained 30 red spheres which were 10 mm in diameter,randomly placed.These spheres were invisible on sonography,but visible on CT.A junior operator and a senior operator performed the biopsy respectively,and each sphere was biopsied once guide by both RVS and conventional ultrasound for each operator.The red dye in thebiopsied sample meant successful performance.The success rate of biopsy and the length of the red dyed sample were recorded.Results There was no statistically difference between the performance results of the two operators.The success rate and the median length of red dyed sample biopsy of RVS were respectively 96.7％ (58/60) and 7.5 mm (rang,6-9 mm) which were statistically higher and longer than that of conventional ultrasound,43.3％(26/60) and 0 mm(rang,0 - 5 mm) ( P ＜0.05).ConclusionsBiopsy guided by RVS for the target invisible to ultrasound is a feasible and accuracy method,which will be a new guided method for interventional ultrasound.