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Introducción. La hipertensión portal (HTP) se define como una elevación anormal de la presión venosa en el sistema portal que lleva al desarrollo de vías colaterales para desviar el flujo sanguíneo de la zona. Dentro de su etiología están las relacionadas con la cirrosis hepática y otras causas denominadas no cirróticas. El objetivo de este estudio fue evaluar los principales hallazgos demográficos, clínicos y paraclínicos en un grupo de pacientes con HTP, y determinar el uso de ayudas invasivas y no invasivas, y su disponibilidad para el diagnóstico y seguimiento de los pacientes en los centros que no cuentan con laboratorio de hemodinamia hepática, reflejando la dinámica de múltiples escenarios en Colombia. Metodología. Se realizó un estudio descriptivo de corte transversal, retrospectivo, en pacientes atendidos en una institución de tercer nivel del sur de Colombia, entre enero del año 2015 y diciembre del año 2020. Resultados. Se obtuvo una muestra de 61 pacientes en donde la mayoría de casos correspondían a hombres en la séptima década de la vida, procedentes del área urbana. La principal causa de consulta fue el sangrado digestivo (39,3 %), asociado a la presencia de telangiectasias (arañas vasculares) en el 37,2 %, seguido de circulación colateral (31,3 %) e ictericia (19,7 %). En la ecografía abdominal (realizada en el 57,4 % de los pacientes) predominaron la cirrosis (68 %) y la presencia de esplenomegalia (14,2 %), y en lospacientes con Doppler portal (realizado en el 16,4 %) se encontró hígado cirrótico (80 %) y dilatación portal (40 %). Con respecto a los hallazgos en la esofagogastroduodenoscopia predominó la presencia de várices esofágicas y gastritis crónica. Conclusión. El principal motivo de consulta fue el sangrado digestivo, en tanto que la cirrosis fue el antecedente y el hallazgo imagenológico más frecuente, seguido de las várices esofágicas. Se encontró que el uso de paraclínicos, ecografía abdominal, ecografía con Doppler portal y esofagogastroduodenoscopia fueron los más utilizados en el contexto clínico de los pacientes con el diagnóstico de HTP.
Introduction. Portal hypertension (PHT) is defined as an abnormal elevation of venous pressure in the portal system that leads to the development of collateral pathways to divert blood flow from the area. Within its etiology are those related to liver cirrhosis and other so-called non cirrhotic causes. The aim of this study was to evaluate the main demographic, clinical and paraclinical findings in a group of patients with PHT, and to determine the use of invasive and non-invasive aids, and their availability for the diagnosis and follow-up of patients in centers that do not have a hepatic hemodynamics laboratory, reflecting the dynamics of multiple scenarios in Colombia. Methodology. A descriptive, retrospective, cross-sectional, retrospective study was conducted in patients attended in a third level institution in Southern Colombia, between January 2015 and December 2020. Results. A sample of 61 patients was obtained where the majority of cases corresponded to men in the seventh decade of life, from the urban area. The main cause of consultation was digestive bleeding (39.3%), associated with the presence of telangiectasias (spider veins) in 37.2%, followed by collateral circulation (31.3%) and jaundice (19.7%). In abdominal ultrasound (performed in 57.4% of the patients), cirrhosis (68%) and the presence of splenomegaly (14.2%) predominated, and in patients with portal Doppler (performed in 16.4%), cirrhotic liver (80%) and portal dilatation (40%) were found. With respect to the findings in the esophagogastroduodenoscopy, esophageal varices and chronic gastritis were predominant. Conclusion. The main reason for consultation was gastrointestinal bleeding, while cirrhosis was the most frequent history and imaging finding, followed by esophageal varices. It was found that the use of paraclinics, abdominal ultrasound, ultrasound with portal Doppler and esophagogastroduodenoscopy were the most used in the clinical context of patients diagnosed with PHT.
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Objective Endothelial injury plays a crucial role in forming deep vein thrombosis.This study aims to compare the effectiveness of various methods for creating rabbit femoral vein thrombotic models after the endothelial injuryso as to provide a solid experimental foundation for further research on the endothelial injury and deep vein thrombosis.Methods Forty-five rabbits were randomly divided into three groups(A,B,C),with 15 cases in each group and subjected to the endothelial injury using the methods of simple clamping,combined complete ligation,and combined incomplete ligation,respectively.The intravascular ultrasonic manifestations and local endothelial pathological changes were compared at 1,3,and 7 days after modeling.Results Significant differences in vascular diameter and Young's modulus values were observed after 7 days of modeling(P<0.05).In pairwise comparisons between the groups,the Young's modulus values in group C were significantly higher than those in groups A and B after 7 days of modeling(P<0.05).Pathological examination confirmed the presence of fibr-inoid thrombus in the blood vessels of group C on the seventh day of modeling.Conclusion Combining simple clam-ping and incomplete ligation can produce a relatively stable endothelial injury and thrombus formation.This method provides a robust experimental model for further investigation into deep vein thrombosis after the endothelial injury.
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Objective:To establish a nomogram model based on elastic imaging parameters and ultrasound image features, and evaluate its predictive value in central lymph node metastasis (CLNM) in papillary thyroid carcinoma (PTC) .Methods:The clinical data of 168 patients (the research group) with papillary thyroid carcinoma who underwent thyroid surgery in our hospital from Jan. 2019 to Dec. 2021 were retrospectively collected, including gender, age, ultrasound elastography parameters (elasticity ratio, blue area ratio), and ultrasound examination indicators (nodule diameter, nodule number, internal echo, border, edge, aspect ratio, microcalcification, capsule invasion). Another 150 patients who underwent thyroid surgery in our hospital during the same period were selected as the validation group.According to the results of postoperative pathological examination, the the research group were divided into two groups: 64 cases (38.10%) of CLNM and 104 cases (61.90%) of non-CLNM. Binary logistic regression analysis was used to explore the influencing factors of CLNM in PTC patients, and a nomogram model based on elastic imaging parameters and ultrasound image features was established. The nomogram model was drawn to predict the receiver operating characteristic (ROC) curve of CLNM in PTC patients.Results:There were statistically significant differences in nodule diameter, edge, microcalcification, capsule invasion, blue area ratio, and elasticity ratio ( P<0.05). Most of the nodules in the CLNM group were ≥10 mm in diameter, with uneven margins, an aspect ratio of <1, microcalcifications and capsular invasion. Logistic regression analysis showed that nodule diameter, capsule invasion, blue area ratio and elastic ratio were risk factors for CLNM ( P<0.05). The AUC of the combined detection was 0.857 (0.777-0.937), and the sensitivity and specificity were 78.1% and 86.5%, respectively, and the AUC and sensitivity were significantly higher than the individual detection of each index ( P<0.05). In the research group, the sensitivity and specificity of the ultrasound parameter prediction model in predicting CLNM were 81.25% (52/64) and 84.62% (88/104), respectively. In the validation group, the sensitivity and specificity of the ultrasound parameter prediction model in predicting CLNM were 79.17% (38/48) and 85.29% (87/102), respectively. Conclusion:Elastography parameters (blue area ratio, elasticity ratio) and ultrasound image features (nodule diameter, capsular invasion) are the influencing factors of CLNM in PTC patients, and the combined prediction based on the above four indicators has good application value.
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BACKGROUND:In clinical work,the stiffness of neck soft tissue in patients with neck and shoulder pain is mainly detected through palpation,which is highly subjective and lacks an objective basis.Real-time shear wave elastography is a quantitative elastic ultrasound technique that can objectively assess muscle elasticity and muscle status. OBJECTIVE:To apply real-time shear wave elastography to assess the stiffness of scalene muscles in patients with neck and shoulder pain and to observe the characteristics of muscle stiffness changes in the bilateral anterior,middle and posterior scalene muscles in patients with neck and shoulder pain. METHODS:From December 2021 to June 2022,36 healthy subjects(control group)and 36 patients with neck and shoulder pain(test group)were recruited at the Shenzhen Hospital of Guangzhou University of Chinese Medicine.Real-time shear wave elastography was applied to measure the mean values of elastic modulus and cross-sectional area of the anterior and middle and posterior scalene muscles bilaterally in the neutral and lateral flexion positions of the neck in both groups. RESULTS AND CONCLUSION:In the same position,there were no significant differences between the mean Values of elastic modulus of the left and right anterior scalene muscles as well as between the mean Values of elastic modulus of the left and right middle scalene muscles in each group(P>0.05);there were no significant differences between the cross-sectional area of the left and right anterior scalene muscles as well as the cross-sectional area of the left and right posteromedial scalene muscles in each group(P>0.05);and the elastic modulus and cross-sectional area of the posteromedial scalene muscles were significantly higher than those of the anterior scalene muscles in both groups(P<0.01,P<0.001).The mean Values of elastic modulus of the anterior and posteromedial scalene muscles were higher in the test group than in the control group in the neutral and lateral neck flexion positions(P<0.001),while the cross-sectional areas of the anterior and posteromedial scalene muscles were lower than those in the control group(P<0.01,P<0.001).To conclude,real-time shear wave elastography can be used to visually evaluate the differences in the mean Values of elastic modulus of the anterior and posteromedial scalene muscles in different states of the neck muscles in patients with neck and shoulder pain,whose bilateral scalene muscles are in a state of strain and stiffness.
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Objective:To explore the diagnostic value of ultrasound elastography (UE) in patients with obese polycystic ovary syndrome (PCOS).Methods:A total of 86 PCOS patients diagnosed in the Second People′s Hospital of Beilun District, Ningbo City from June 2019 to April 2022 were selected as the study group, including 32 patients with body mass inde(BMI) ≥25 kg/m 2 (obese group) and 54 patients with BMI < 25 kg/m 2 (non-obese group). Another 40 women with healthy physical examination and matching age and BMI of the study group were selected as the normal control group. All of them underwent routine vaginal ultrasound and UE examination, and the differences of parameters in each group were compared. The receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic efficacy of relevant parameters for PCOS and obesity PCOS. Results:The number of follicles and ovarian volume in the study group were higher than those in the normal control group, and the PI and RI of ovarian interstitial artery were lower than those in the normal control group: (17.50 ± 3.23) unit vs. (8.15 ± 2.01) unit, (12.97 ± 3.20) ml vs. (5.36 ± 1.82) ml, 0.82 ± 0.14 vs. 0.93 ± 0.20, 0.52 ± 0.12 vs. 0.58 ± 0.10, there were statistical differences ( P<0.05). The number of follicles and ovarian volume in the obese group were significantly higher than those in the non-obese group: (18.98 ± 3.45) unit vs. (16.62 ± 3.17) unit, (15.00 ± 3.15) ml vs. (11.77 ± 2.63) ml, there were statistical differences ( P<0.05); but the PI and RI between the obese group and the non-obese group had no significant differences ( P>0.05). In the study group, 56 cases (65.12%) had type 1 elastic pattern, which was significantly higher than 4 cases (10.00%) in the normal control group ( χ2 = 17.61, P<0.01). The elastic pattern was no significant difference between the obese group and the non-obese group ( P>0.05). The elastic coefficient (B/A ratio) in the study group was higher than in the normal control group:7.86 ± 1.51 vs. 4.53 ± 1.10, there was statistical difference ( P<0.05). The B/A ratio in the obese group was higher than that in the non-obese group and the normal control group: 8.76 ± 1.35 vs. 7.32 ± 1.34, 4.53 ± 1.10, there were statistical differences ( P<0.05). The ROC curve analysis showed that the area under the curve (AUC) of B/A ratio for the diagnosis of PCOS was 0.962, when the cut-off value was 5.56, the corresponding sensitivity and specificity were 93.02% and 87.50%. The AUC of B/A ratio for the diagnosis of obese PCOS was 0.788, when the cut-off value was 8.35, the corresponding sensitivity and specificity were 78.12% and 85.19%. Conclusions:The UE has great diagnostic value for PCOS and certain discrimination performance for obese PCOS.
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Objective:Exploring the value of contrast enhanced ultrasound (CEUS) plus transient elastography in evaluating donor livers for C-I donors and predicting the occurrence of early allograft dysfunction (EAD).Methods:Between September 1, 2022 and August 31, 2023, the relevant clinical data were retrospectively reviewed for 75 pairs of donors and recipients. Based upon whether or not there was a postoperative onset of EAD, the recipients were assigned into two groups of EAD (16 cases) and non-EAD (59 cases) . All donors were examined by contrast-enhanced ultrasonography and FibroScan. QLAB analysis software was utilized for analyzing the results of contrast-enhanced ultrasound. Liver parenchyma at 3 cm below liver capsule was selected as a region of interest for plotting the time-intensity curve (TIC) . And the contrast-enhanced ultrasonic parameters of two groups were recorded. FibroScan transient elastography instrument was employed for quantifying liver stiffness 12 times in right lobe of donor liver and recording quantitative parameters of liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) .Results:Inter-group comparison of gender, age, body mass index (BMI) and ICU length of stay showed no statistically significant differences ( P>0. 05) . However, significant differences existed in the levels of platelet [ (122. 44±85. 82) vs (197. 22± 140. 93) ×10 9/L]and cholinesterase [ (3 473. 44±1 368. 54) vs (4 252. 93±1 365. 37) U/L]within the first 24h pre-operation ( P=0. 047, P=0. 047) . Peak intensity (PKI) and area under the curve (AUC) were lower in EAD group than those in non-EAD group [ (16. 44±4. 70) dB vs 19. 85±4. 39 dB, P=0. 009; (1 366. 76±508. 10) dB·s vs (1 675. 23±498. 77) dB·s, P=0. 014]. There were statistically significant differences ( P=0. 009, P=0. 032) . Arterial-portal arrival interval (APAI) and LSM were higher in EAD group than those in non-EAD group[6. 50 (5. 00, 10.75) s vs 5. 00 (4. 00, 7. 00) s, P =0. 24; 8. 60 (6. 32, 11. 65) kPa vs 6. 10 (5. 40, 7. 90) kPa, P=0. 014]. Receiver operating characteristic (ROC) curve analysis revealed that PKI, AUC, APAI and LSM had AUC values of 0. 703, 0. 664, 0. 683 and 0. 702, respectively in predicting postoperative EAD. And combined prediction of EAD occurrence based upon these parameters had an AUC of 0. 776, a Youden index of 0. 508 with cutoff values, sensitivity and specificity of 0. 800, 0. 813 and 0. 695 respectively. Spearman' s correlation analysis revealed a negative correlation between APAI and AUC values ( r= -0. 404, P<0. 001) . Conclusions:The combination of CEUS and transient elastography can comprehensively evaluate the status of microcirculatory perfusion, fibrosis and steatosis of liver grafts from brain death donors. It offers a great predictive value for postoperative occurrence of EAD.
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【Objective】 To explore the application value of transrectal contrast-enhanced ultrasound (CEUS) microangiography, elastography and conventional ultrasound-guided prostate cancer puncture biopsy in the diagnosis of prostate diseases, so as to provide reference for the early diagnosis of prostate cancer. 【Methods】 A total of 156 patients suspected of prostate cancer treated in our hospital during Jan.2021 and Dec.2022 were selected.The patients were divided into group A (n=52, conventional ultrasound), group B (n=49, elastography) and group C (n=55, CEUS microangiography) according to the puncture methods.The positive rate of puncture and diagnostic value of the three methods were analyzed. 【Results】 The positive rate of puncture was 24.18% in group B and 25.71% in group C, which was significantly higher than that in group A (13.15%, P<0.05).The diagnostic accuracy of prostate cancer was 93.88% in group B and 94.55% in group C, higher than that in group A (75.00%, P=0.002).In group B, the Emax and Emean of malignant lesions were (65.56±14.43) kPa and (59.59±11.02) kPa, respectively, which were higher than those of benign lesions (P<0.001).The difference in blood flow grade detected by CEUS microangiography was statistically significant between benign and malignant lesions, and grade 3 blood flow accounted for 95.65% of malignant lesions.The area under the receiver operating characteristic (ROC) curve (AUC) of Emean in elastography in the diagnosis of prostate cancer was 0.810 (95%CI: 0.690-0.930, P<0.05).The AUC of CEUS microangiography in the diagnosis of prostate cancer was 0.965 (95%CI: 0.913-1.000, P<0.05). 【Conclusion】 Compared with conventional ultrasound-guided prostate cancer puncture biopsy, CEUS microangiography and elastography guided prostate cancer puncture biopsy have better application value in the diagnosis of prostate diseases, which can provide semi-quantitative/quantitative parameter basis for the diagnosis of prostate diseases.
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Objective @#To investigate the diagnostic efficacy of the nomogram model based on Chinese thyroid ima ging reporting and data system (C TIRADS) combined with shear wave elastography ( SWE) and clinically inde pendent risk factors for category IV thyroid nodules .@*Methods @#2D-ultrasound images and SWE images of 256 pa tients (269 nodules ) with category IV thyroid nodules were analyzed . The sensitivity , specificity , and accuracy of the diagnosis by C-TIRADS and SWE were calculated using pathological findings as the gold standard . Receiver op erating characteristic (ROC) curves were plotted , and the area under the curve (AUC) was obtained . Independent risk factors for thyroid nodules were screened by univariate and multifactorial logistic regression analyses , a risk model was developed and a nomogram model was plotted , and a calibration curve analysis was used to assess the accuracy of prediction . ROC of the nomogram model was plotted , and the diagnostic efficacy of C-TIRADS , SWE and nomogram model based on independent risk factors was compared according to the AUC in category IV thyroid nodules . @*Results @#The sensitivity , specificity , and accuracy of C-TIRADS for differentiating malignant and benign nodules was 0.921 , 0.724 and 0.844 respectively , the AUC was equal to 0.822 with a 95% confidence interval (95% CI) of 0.775 - 0.870 . The sensitivity , specificity and accuracy of SWE were 0.701 , 0.981 , 0.814 respec tively , and the AUC was 0.833 (95% CI: 0.795 - 0.872) . Multifactorial logistic regression analysis suggested that C-TIRADS classification , mean value of elasticity (E-mean ) age and aspect ratio were independent risk factors for identifying benign and malignant thyroid nodules . The sensitivity , specificity and accuracy of the nomogram model established based on the above four factors were 0.957 , 0.943 and 0.959 , the AUC was 0.963 (95% CI: 0.943 - 0.984) , which showed a diagnostic efficacy superior to that of C-TIRADS or SWE alone .@*Conclusion@#The nomogram model , constructed based on C-TIRADS , SWE and clinically independent risk factors , can improve the efficacy in diagnosing category IV thyroid nodules , with a better clinical application value .
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Hepatic echinococcosis is a chronic parasitic disease, which is caused by the larvae of Echinococcus multilocularis. It has a high risk of disability and mortality, which is also known as "parasite cancer". In clinical practice, hepatic echinococcosis can be divided into hepatic alveolar echinococcosis and hepatic cystic echinococcosis. Hepatic echinococcosis is widely prevalent worldwide. It mainly occurs in the populations residing agricultural and pastoral areas in western China, posing significant threats to the quality of life of local residents. At present, surgery is the main treatment for hepatic echinococcosis in clinical settings. With rapid development of surgical diagnosis and treatment technology and deepening understanding of hepatic echinococcosis, diagnosis and treatment regimens have also been constantly improved. In this article, research progresses on the diagnosis and treatment of hepatic alveolar echinococcosis were reviewed, aiming to provide reference for clinicians, deliver early diagnosis and treatment, mitigate adverse effects of this disease upon patients and improve clinical prognosis.
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Purpose To explore the correlation between phosphatidylinositol 3 kinase/serine-threonine kinase(PI3K/AKT)signaling pathway and elastic characteristics of breast lesions.Materials and Methods A total of 115 breast lesions were prospectively analyzed in 114 patients who underwent surgery from May 2021 to May 2022 at Chinese PLA General Hospital.Ultrasound and shear wave elastography were performed preoperatively.Immunohistochemical staining was used to detect the expression of PI3K/AKT protein levels in the tissue specimens,and the correlation between the staining results and the elastic parameters of shear wave elastography was analyzed.Results Surgical pathology revealed benign breast lesions in 50 cases and malignant lesions in 65 cases(25 cases with axillary lymph node metastasis).The maximum modulus of elasticity(F=40.47),the average modulus of elasticity(F=45.11),the ratio of elasticity of the lesion to that of the surrounding tissue(F=48.98),the detection rate of"hard ring sign"(χ2=62.25),the expression level of PI3K/p-PI3K(F=15.19,58.95)and AKT/p-AKT(F=46.94,74.21)were found in benign and malignant lesions without axillary lymph node metastasis,malignant lesions with axillary lymph node metastasis(all P<0.05).The expression levels of PI3K/p-PI3K and AKT/p-AKT were positively correlated with the maximum elastic modulus value,the mean elastic modulus value,and the ratio of elasticity of the lesion to the surrounding tissues(r=0.475,0.475,0.451;r=0.533,0.540,0.542;r=0.371,0.402,0.445;r=0.482,0.455,0.545,all P<0.05).Conclusion The expression level of PI3K/AKT in breast lesions is correlated with elastic characteristics,suggesting that it plays an important role in the regulation of elastic characteristics of breast lesions.
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Objective:To explore the application value of 3.0T magnetic resonance imaging(MRI)combined with transvaginal ultrasound elastography technique in diagnosing uterine fibroids and adenomyosis.Methods:A retrospective analysis was performed on 56 patients with uterine fibroids and 41 patients with adenomyosis who admitted to Fengfeng General Hospital of North China Medical and Health Group from January 2021 to January 2022.MRI and transvaginal ultrasound elastography were respectively performed on all patients,and pathological diagnosis was taken as the"gold standard".The diagnostic results of MRI,transvaginal ultrasound elastography technique and their combination were compared,and the diagnostic situation of different examination methods were recorded.And then,the total coincidence rate was analyzed,and the sensitivity,specificity and accuracy were further calculated.Results:The totally diagnostic coincidence rate of MRI combined with transvaginal ultrasound elastography was 96.43% in detecting uterine fibroids,and that of MRI was 75.00%,and that of transvaginal ultrasonography was 80.36%.The differences of totally diagnostic coincidence rates among combined detection and single detection were significant(x2=10.500,7.049,P＜0.05).The totally diagnostic coincidence rate of MRI combined with transvaginal ultrasound elastography was 97.56% in detecting adenomyosis,which was significantly higher than that(78.05%)of MRI and that(78.05%)of transvaginal ultrasound elastography,and the differences were significant(x2=7.289,7.289,P＜0.05).The sensitivities of single MRI,single transvaginal ultrasound elastography and the combined detection of them were 71.74%,78.26% and 95.62% in detecting uterine fibroids,and the specificities of them were 90.00%,90.00% and 100.00%,and the accuracies of them were 75.00%,80.36% and 96.43%,respectively.The sensitivity and accuracy of the combined detection were significantly higher than those of single MRI detection(x2=5.029,10.500,P＜0.05),respectively.The accuracy of the combined detection was significantly higher than that of the single detection of vaginal ultrasonography(x2=7.049,P＜0.05).The sensitivities of single MRI,single transvaginal ultrasound elastography and the combined detection of them were 81.25%,78.73% and 96.88% in detecting adenomyosis,and the specificities of them were 66.67%,77.78% and 100.00%,and the accuracies of them were 78.05%,78.05% and 97.56%,respectively.The accuracy of the combined detection was significantly higher than that of single MRI detection(x2=7.289,P＜0.05),and the accuracy of the combined detection was significantly higher than that of single detection of vaginal ultrasonography(x2=7.289,P＜0.05).Conclusion:The diagnosis rate of MRI combined with transvaginal ultrasound elastography technique is higher for uterine fibroids and adenomyosis,which has better diagnostic value,and can provide reliable reference materials for clinicians in performing treatment.
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Objective:To investigate the diagnostic value of ultrasound elastography combined with serum microRNA-26b-5p(miR-26b-5p)and cyclooxygenase-2(COX-2)detection for early hysteromyoma.Methods:A total of 228 patients with suspected early hysteromyoma who were diagnosed in the 90th Hospital of the Joint Service Support Center from October 2020 to September 2022 were selected as the observation objects.Based on the results of pathological section examination as the"gold standard",all subjects were divided into a positive group(124 cases)and a negative group(104 cases),and ultrasound elasticity imaging examination was performed in both groups.The expression level of miR-26b-5p in serum was detected by real-time fluorescent quantitative polymerase chain reaction(Rt-PCR),and the level of serum COX-2 was detected by enzyme-linked immunosorbent assay(ELISA),and receiver operating characteristic(ROC)curve was applied to analyze the diagnostic values of serum miR-26b-5p and COX-2 for hysteromyoma.The four tables were applied to analyze the diagnostic values of ultrasound elastography and the combination of ultrasound elastography,serum miR-26b-5p and COX-2 for hysteromyoma.Results:The results of pathological examination indicated that 124 cases of 228 patients were positive result of hysteromyoma and 104 cases were negative result.The results of ultrasound elastography showed that 117 cases were positive,and 111 cases were negative,and the diagnostic sensitivity,specificity and accuracy of ultrasound elastography detection were respectively 74.19%,75.96%and 75.00%.Serum miR-26b-5p level of positive group was significantly lower than that of negative group,while the COX-2 level of positive group was significantly higher than that of negative group,and the differences of them between the two groups were statistically significant(t=4.519,5.601,P<0.05),respectively.The area under curve(AUC)value of ROC curve,sensitivity,specificity and the best cut-off value of serum miR-26b-5p were respectively 0.749,95.97%,46.15%and 1.10 in diagnosing hysteromyoma.The above indicators of serum COX-2 were respectively 0.835,66.13%,84.62%and 40.58 mg/L in diagnosing hysteromyoma.The sensitivity,specificity and accuracy of ultrasound elastography combined with serum miR-26b-5p and COX-2 were respectively 93.55%,86.54%and 90.35%,the differences were statistically significant(x2=23.158,17.169,P<0.05),respectively.Conclusion:Ultrasound elastography combined with serum miR-26b-5p and COX-2 has higher effectiveness in diagnosing the early hysteromyoma.
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Objective:To investigate the application value of shear wave elastography (SWE) in the evaluation of T re-staging after neoadjuvant chemoradiotherapy (nCRT) for locally advanced rectal cancer.Methods:Clinical, endorectal ultrasound (ERUS) and SWE data of 271 patients with locally advanced rectal cancer who underwent nCRT and total mesorectal excision in Fujian Medical University Union Hospital from October 2021 to March 2023 were prospectively collected. The independent predictors for low T staging were analyzed and screened, and the Logistic regression model was constructed. An independent test set was used to validate the prediction performance of the models and compare them with the diagnostic results of sonographers.Results:Binary multivariate Logistic regression analysis showed that Emean of the mesentery around the lesion, thickness, and enlarged lymph nodes around the rectum were the independent predictors for low T staging, and the odds ratios were 1.089, 1.214, 0.183, respectively. The Logistic regression model A established by Emean, thickness and enlarged lymph nodes around the lesion and the Logistic regression model B established by Emean around the lesion had high diagnostic efficiencies (area under the ROC curve were 0.931, 0.918, respectively, the accuracy were 0.888 and 0.887, respectively). There was no significant difference in diagnostic accuracy between the two models ( P=1.000), and both models were significantly higher than that of sonographers (all P<0.001). Conclusions:SWE can effectively predict whether the tumor is of low T staging after nCRT in locally advanced rectal cancer, and can be used as an important supplement to ERUS in evaluating the T re-staging of rectal cancer after nCRT.
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Objective:To investigate the value of a novel technique called visual transient elastography (ViTE) and liver steatosis analysis (LiSA) in assessing liver function injury in hepatitis B virus-related hepatocellular carcinoma (HBV-related HCC) patients after ablation therapy.Methods:A total of 129 HBV-related HCC patients in Harbin Medical University Cancer Hospital from January 2022 to August 2023 were retrospectively analyzed.ViTE and LiSA examinations were applied to record the liver stiffness E value and LiSA value before ablation. An albumin-bilirubin (ALBI) score was constructed using laboratory indicators. Spearman correlation analysis was used to assess the correlation between E value, LiSA value and ALBI score, body mass index (BMI). According to the change of ALBI grade in perioperative period, the patients could be divided into two groups: liver function unchanged group and liver function injury group. Univariate and multivariate statistical methods were used to analyze related factors affecting changes in liver function after ablation, followed by establishing a predictive model.Results:Spearman analysis showed a strong positive correlation between E value and ALBI score ( rs=0.686, P<0.001), and LiSA value was weakly positively correlated with BMI ( rs=0.338, P<0.001). There were no significant correlations between E value and BMI, LiSA value and ALBI score (all P>0.05). Univariate analysis showed that differences of age, BMI, ablation parameters, E value, and LiSA value in the two groups were statistically significant (all P<0.05). Multivariate analysis showed that E value, LiSA value, and ablation time were independent predictors of hepatic dysfunction after ablation (all P<0.05). AUC was 0.892 indicating high accuracy in the predictive model based on above indicators. Conclusions:Under the real-time ultrasound guidance, a non-invasive liver function injury prediction model based on ViTE and LiSA technology can offer personalized predictions for ablative perioperative changes in liver function among HBV-related HCC patients.
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Objective To investigate the clinical application value of transrectal real-time tissue elastography(TRTE)guided targeted puncture in the diagnosis of prostate cancer.Methods A total of 52 patients with suspected prostate cancer who were treated in the First People's Hospital of Zhengzhou from January 2020 to December 2022 were selected as the study objects.Preoperative routine transrectal ultrasound and TRTE examination were performed to evaluate the benign and malignant prostates.For the 28 patients with suspected lesions found in TRTE,TRTE-guided targeted puncture(2 needles)+ systematic puncture(8 needles)were performed,for the 24 patients with no suspicious lesions found in TRTE,routine ultrasound-guided systematic puncture(12 needles)was performed.The efficacy of TRTE in the diagnosis of prostate cancer was analyzed and the positive rate of targeted puncture and systematic puncture was compared.Results In this study,25 cases of prostate cancer and 27 cases of benign lesions were ultimately pathologically diagnosed,while a total of 28 cases of prostate cancer and 24 cases of benign lesions were diagnosed with TRTE.The positive predictive value and negative predictive value of the diagnosis were 75.0%(21/28)and 83.3%(20/24),respectively.In 28 patients with suspected lesions found by TRTE,a total of 56 needles were targeted puncture,36 needles were diagnosed with prostate cancer,positive rate was 64.29%(36/56),and a total of 224 needles were systematic puncture,89 needles were diagnosed with prostate cancer,with a positive rate of 39.73%(89/224).The positive rate of prostate cancer by targeted puncture was significantly higher than that by systematic puncture(P<0.05).Conclusion TRTE can better diagnose prostate cancer,and its guided targeted puncture has a higher positive rate in the diagnosis of prostate cancer,which can maximize the positive rate of puncture while reducing the number of puncture needles.
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@#Objective To explore the application value of ultrasound microvascular imaging combined with shear wave elastography in differentiating thyroid ultrasound image reporting and data system(TI-RADS)4 benign and malignant thyroid nodules.Methods Totally 114 thyroid nodules diagnosed as ACR TI-RADS 4 in Hangzhou traditional Chinese medicine hospital from November 2021 to December 2022 were retrospectively selected.All nodules were examined by ultrasound microvascular imaging and shear wave elastography,and compared with the surgical pathological results to evaluate the diagnostic efficacy of microvascular imaging,shear wave elastography and the combination of the two.Results Among 114 cases of thyroid TI-RADS type 4 nodules,35 cases were benign nodules,79 cases were malignant nodules.The microvascular pattern of malignant nodules was mainly concentrated and interrupted sign and perforator sign.The Emax value of shear wave elastography was statistically significant in differentiating benign from malignant nodules,and the SWE Emax value of malignant nodules was greater than 41.6kPa(P<0.05).The sensitivity,specificity and accuracy of ultrasound microvascular imaging combined with shear wave elastography in the diagnosis of thyroid TI-RADS 4 nodules were 96.20%,65.72%and 86.84%,respectively,and the area under curve(AUC)was 0.810.The sensitivity and accuracy were higher than those of single diagnosis mode,and the difference was statistically significant(P<0.05).Conclusion Ultrasound microvascular imaging combined with shear wave elastography can improve the diagnostic efficiency of benign and malignant thyroid TI-RADS 4 nodules with high diagnostic sensitivity and accuracy,which is helpful for the noninvasive differential diagnosis of such nodules and avoids some unnecessary needle biopsy.
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Objective To assess the value of multimodal ultrasonography for diagnosing thyroid nodules—atypia of undetermined significance (AUS) of thyroid imaging reporting and data system (TI-RADS) categories 3 to 5. Methods A total of 90 AUS thyroid nodules in TI-RADS 3-5 categories from 88 patients underwent conventional ultrasonography, ultrasound elastography, superb microvascular imaging, and multimodal ultrasonography at the same time. With fine needle aspiration biopsy results as the gold standard, the methods were compared in terms of the sensitivity, specificity, accuracy, false positive rate (FPR), false negative rate (FNR), and area under the receiver operating characteristic curve (AUC) for diagnosing thyroid nodules. Results There were no significant differences between patients with benign and those with malignant thyroid nodules in terms of sex, age, and nodule locations (all P > 0.05), but the proportion of thyroid nodules ≤ 1 cm in diameter was significantly higher for malignant thyroid nodules than for benign thyroid nodules (χ2=9.610, P=0.002). Compared with benign nodules, malignant nodules were significantly more frequent to have low-level echoes or very low-level echoes, a blurred margin, a vertical diameter/horizontal diameter ratio of > 1, and microcalcifications or no calcifications (all P < 0.05). An ultrasound elastography score of ≥ 3 and type III vascularity on superb microvascular imaging indicated a higher possibility of malignant thyroid nodules (both P < 0.001). The multivariable logistic regression analysis showed that the size, echogenicity, margin, and vertical diameter/horizontal diameter ratio, and superb microvascular imaging type of thyroid nodules were not significant markers for benign or malignant thyroid nodules (all P > 0.05), while microcalcifications/no calcifications and an ultrasound elastography score of ≥ 3 were independent risk factors for malignant AUS nodules (both P < 0.05). The diagnostic sensitivity, specificity, accuracy, FPR, and FNR of conventional ultrasonography for AUS nodules were 91.30%, 71.40%, 62.70%, 28.60%, and 8.70%, respectively; the values for ultrasound elastography were 85.50%, 66.70%, 52.20%, 33.30%, and 14.50%, respectively; the values for superb microvascular imaging were 66.70%, 76.20%, 42.90%, 23.80%, and 33.30%, respectively; and the values for multimodal ultrasonography were 75.20%, 92.50%, 67.70%, 24.80%, and 7.50%, respectively. For distinguishing between benign and malignant AUS nodules, the AUC values of conventional ultrasonography, ultrasound elastography, superb microvascular imaging, and multimodal ultrasonography were 0.866, 0.745, 0.774, and 0.918, respectively. Conclusion Multimodal ultrasonography shows better diagnostic efficacy for AUS nodules of TI-RADS 3-5 compared with conventional ultrasonography, ultrasound elastography, and superb microvascular imaging, which can facilitate the malignancy risk stratification and management of AUS thyroid nodules.
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ObjectiveTo investigate the value of contrast-enhanced ultrasound （CEUS） combined with shear wave elastography （SWE） in the diagnosis of liver tumors. MethodsThis study was conducted according to the PRISMA guideline， with a PROSPERO registration number of CRD42023491288. PubMed， Embase， the Cochrane Library， CNKI， VIP， and Wanfang Data were searched for articles on CEUS combined with SWE in the diagnosis of liver tumors published from January 2000 to October 2023， and a total of 12 articles were included， with 1 328 patients in total. The QUADAS-2 tool was used to assess the quality of the articles included. Stata 15.0 software was used to calculate pooled sensitivity， specificity， positive likelihood ratio， negative likelihood ratio， diagnostic odds ratio， and heterogeneity. The summary receiver operating characteristic （SROC） curve was plotted， and the area under the SROC curve （AUC） was calculated. ResultsThere were 1 457 lesions for the patients included， among whom there were 764 malignant lesions and 693 benign lesions， with a positive rate of 52.44% and a negative rate of 47.56%. Calculations obtained a pooled sensitivity of 0.94 （95% confidence interval ［CI］： 0.91 — 0.96）， a specificity of 0.92 （95%CI： 0.87 — 0.95）， a positive likelihood ratio of 12.00 （95%CI： 7.40 — 19.40）， a negative likelihood ratio of 0.06 （95%CI： 0.04 — 0.10）， and a diagnostic odds ratio of 191 （95%CI： 87 — 417）. The tests for heterogeneity showed Q=54.78， df=11.00， P<0.001， and I2=79.92% （95%CI： 69.18% — 90.66%）， with an AUC of 0.98. ConclusionCEUS combined with SWE has a relatively high diagnostic value for benign and malignant liver tumors and thus holds promise for clinical application.
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Introducción: Las hepatopatías son un problema prevalente a nivel mundial. La biopsia hepática ha sido hasta la fecha el gold standard para valorar el grado de fibrosis, sin embargo, con el advenimiento de nuevos métodos no invasivos, costo-efectivos para el sistema sanitario, cada vez recurrimos menos a esta. En nuestro medio se introdujo recientemente la elastografía por onda cizallamiento con imagen biplanar, lo que implica una curva de aprendizaje por parte de los técnicos. Objetivo: Valorar la asociación de los grados de fibrosis hepática determinado por la elastografía por onda de cizallamiento con imagen biplanar (2D-SWE) y el score APRI en pacientes portadores de enfermedad hepática asistidos en el servicio de hepatología del Hospital Pasteur.Médica 2. Metodología: Se incluyeron los pacientes con enfermedad hepática de cualquier etiología, asistidos entre el 01/10/21 al 31/08/22, mayores de 15 años, de ambos sexos y que han sido valorados con elastografía por onda de cizallamiento con imagen biplanar (2D-SWE) y analítica sanguínea realizado por el equipo médico del servicio mencionado en los últimos 6 meses. Resultados: Se incluyeron 158 pacientes. Se encontró mayor prevalencia de enfermedad hepática en mujeres, con predominio de la etiología de enfermedad por hígado graso no alcohólico (EHGNA) e infección por virus de hepatitis C (VHC). Se evidenció asociación positiva entre la elastografía (2D-SWE) y el score APRI para el diagnóstico o exclusión de enfermedad hepática avanzada, sin diferencia estadísticamente significativa entre los dos médicos hepatólogos. Conclusiones: Existe asociación entre la elastografía por SWE y el score APRI para el diagnóstico de enfermedad hepática avanzada en la población general y por etiología.
Introduction: Liver diseases are a prevalent problem worldwide. To date, liver biopsy has been the gold standard for assessing the degree of fibrosis; however, with the advent of new non-invasive, cost-effective methods for the healthcare system, we are resorting to it less and less. Shear wave elastography with biplanar imaging was recently introduced in our setting, which implies a learning curve for technicians. Objective: To assess the association of the degrees of liver fibrosis determined by shear wave elastography with biplanar imaging (2D-SWE) and the APRI score in patients with liver disease treated in the hepatology service of the Pasteur Hospital. Methodology: Patients with liver disease of any etiology, attended between 01/10/21 and 08/31/22, over 15 years of age, of both sexes and who have been evaluated with shear wave elastography with biplanar image were included. (2D-SWE) and blood analysis performed by the medical team of the aforementioned service in the last 6 months. Results: 158 patients were included. A higher prevalence of liver disease was found in women, with a predominance of the etiology of nonalcoholic fatty liver disease (NAFLD) and hepatitis C virus (HCV) infection. A positive association was evident between elastography (2D-SWE) and the APRI score for the diagnosis or exclusion of advanced liver disease, with no statistically significant difference between the two hepatologists. Conclusions: There is an association between SWE elastography and the APRI score for the diagnosis of advanced liver disease in the general population and by etiology.
Introdução: As doenças hepáticas são um problema prevalente em todo o mundo. Até o momento, a biópsia hepática tem sido o padrão ouro para avaliar o grau de fibrose, porém, com o advento de novos métodos não invasivos e de baixo custo para o sistema de saúde, recorremos cada vez menos a ela. A elastografia por onda de cisalhamento com imagem biplanar foi introduzida recentemente em nosso meio, o que implica uma curva de aprendizado para os técnicos. Objetivo: Avaliar a associação dos graus de fibrose hepática determinados pela elastografia por ondas de cisalhamento com imagem biplanar (2D-SWE) e o escore APRI em pacientes com hepatopatia atendidos no serviço de hepatologia do Hospital Pasteur. Metodologia: Foram incluídos pacientes portadores de doença hepática de qualquer etiologia, atendidos entre 10/01/21 e 31/08/22, maiores de 15 anos, de ambos os sexos e que foram avaliados com elastografia por onda de cisalhamento com imagem biplanar. ( 2D-SWE) e análises sanguíneas realizadas pela equipa médica do referido serviço nos últimos 6 meses. Resultados: foram incluídos 158 pacientes. Foi encontrada maior prevalência de doença hepática em mulheres, com predomínio da etiologia da doença hepática gordurosa não alcoólica (DHGNA) e da infecção pelo vírus da hepatite C (HCV). Foi evidente uma associação positiva entre a elastografia (2D-SWE) e o escore APRI para o diagnóstico ou exclusão de doença hepática avançada, sem diferença estatisticamente significativa entre os dois hepatologistas. Conclusões: Existe associação entre a elastografia SWE e o escore APRI para o diagnóstico de doença hepática avançada na população geral e por etiologia.
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ABSTRACT This is a narrative review that aims to discuss the importance of elastographic methods in the evaluation of clinically significant portal hypertension (CSPH) in cirrhotic patients, where the authors propose an algorithm for evaluating these patients. In compensated advanced chronic liver disease, the goal is to prevent the development of CSPH and, in those already with CSPH, prevent the appearance of gastroesophageal varices (GEV) and other complications of portal hypertension. In compensated cirrhosis, the prevalence of GEV is 30-40%, of which 10-20% are at risk of bleeding. Therefore, using non-invasive methods would exempt the patient from the need of an endoscopy. Hepatic Elastography is a non-invasive, safe, reproducible method, available through many techniques: Vibration-Controlled Transient Elastography (VCTE), Shear Wave Elastography (SWE) and Magnetic Resonance Elastography (MRE). The Baveno VII presented the "rule of 5" for VCTE: liver stiffness measurement (LSM) ≤15 kPa and platelets >150.000/mm3 exclude CSPH, while an LSM ≥25 kPa is highly suggestive of CSPH. Also, the "rule of 4" for SWE has been proposed: patients with ≥17 kPa could be considered as having CSPH. At last, spleen stiffness measurement (SSM) has been proposed as a more specific technique to predict the presence of CSPH. In conclusion, elastography has gained prestige in the non-invasive evaluation of patients with advanced chronic liver disease by allowing prophylactic measures to be taken when suggesting the presence of CSPH.
RESUMO Trata-se de uma revisão narrativa que visa discutir a importância dos métodos elastográficos na avaliação da hipertensão portal clinicamente significativa (HPCS) em pacientes cirróticos, onde os autores propõem um algoritmo para avaliação desses pacientes. Na doença hepática crônica avançada compensada, o objetivo é prevenir o desenvolvimento de HPCS, e naqueles já com HPCS prevenir o aparecimento de varizes gastroesofágicas (VGE) e outras complicações da hipertensão portal. Na cirrose compensada, a prevalência de VGE é de 30-40% e 10-20% são varizes com risco de sangramento, portanto o uso de métodos não invasivos dispensaria o paciente de endoscopia. A elastografia hepática é um método não invasivo, seguro e reprodutível, disponível através de várias técnicas: elastografia transitória (VCTE), onda de cisalhamento (SWE) e elastografia por ressonância magnética. O Baveno VII apresentou a "regra dos 5" para VCTE: medida da rigidez hepática (LSM) ≤15 kPa e plaquetas >150.000/mm3 excluem HPCS enquanto um LSM ≥25 kPa é altamente sugestivo de HPCS. Além disso, foi proposta a "regra dos 4" para SWE: pacientes com ≥17 kPa podem ser considerados como portadores de HPCS. Por fim, a medição da rigidez do baço (SSM) foi proposta como uma técnica mais específica para prever a presença de HPCS. Em conclusão, a elastografia ganhou prestígio na avaliação não invasiva de pacientes com doença hepática crônica avançada, ao permitir a adoção de medidas profiláticas ao sugerir a presença de HPCS.