Diagnosis of Thyroid Tumors by Multimodal Ultrasound Imaging / 中国医学影像学杂志

Ultrasound is the imaging modality of choice for the diagnosis of thyroid diseases.The establishment of thyroid imaging reporting and data system based on conventional ultrasound plays a key role in the diagnosis of thyroid tumors.In recent years,new technologies such as elastography,superb microvascular imaging,ultrasonography and artificial intelligence have been widely used in the ultrasound diagnosis of thyroid diseases.The application of multimodal ultrasound technology has greatly improved the diagnostic accuracy of thyroid malignancies and provided a theoretical basis for the formulation of individualized diagnostic and treatment plans for thyroid cancer patients.

Detection and Diagnostic Efficacy of Artificial Intelligence Ultrasound Assisted System for Thyroid Nodules Under Different Ultrasound Parameters / 中国医学影像学杂志

Purpose To explore the differences of the accuracy of detection and recognition of thyroid nodules and the diagnostic efficacy of benign and malignant thyroid nodules via artificial intelligence(AI)ultrasound assisted systems based on different ultrasound parameters.Materials and Methods A total of 147 patients with 289 nodules who underwent thyroid surgery in the First Medical Center of Chinese PLA General Hospital from March 30,2023 to May 1,2023 were prospectively selected.Different ultrasound parameters were adjusted and the AI system was used to detect and diagnose benign and malignant thyroid nodules via each parameter.Taken pathological results as the gold standard,the accuracy of thyroid nodule detection and the accuracy of benign and malignant diagnosis under different ultrasound parameters were compared,respectively.Results Under the standard ultrasound parameters,the accuracy of AI system in detecting thyroid nodules was 94.1%,the sensitivity for benign and malignant diagnosis was 90.9%,the specificity was 79.6%,and the accuracy was 86.6%,respectively.In terms of detection accuracy,accuracy under low gain(χ2=4.453,P=0.035)and high gain(χ2=6.215,P=0.013)parameters of AI system were significantly lower than those of standard ultrasound parameters.In terms of diagnostic efficacy,specificity(χ2=4.620,P=0.032),accuracy(χ2=7.521,P=0.006),area under the curve(Z=3.102,P=0.001),high gain sensitivity(χ2=6.170,P=0.013),accuracy(χ2=4.127,P=0.042),area under the curve(Z=2.152,P=0.031)and high depth accuracy(χ2=5.011,P=0.025),area under the curve(Z=2.420,P=0.015)of low gain were all significantly reduced compared to standard ultrasound parameters,with statistical differences.Conclusion When using the AI system to assist in the examination of thyroid nodules,attention should be paid to the adjustment of ultrasound instrument parameters.Improper parameter adjustment may reduce the AI system's ability to detect thyroid nodules and the accuracy of benign and malignant diagnosis.

Contrast-Enhanced Ultrasound in Assessing the Blood Perfusion of Kidney in Type 2 Diabetic Nephropathy / 中国医学影像学杂志

Purpose To explore the clinical value of quantitative assessment of renal perfusion using ultrasound contrast imaging for the auxiliary diagnosis of type 2 diabetic nephropathy.Materials and Methods This prospective study was conducted from May 2017 to December 2019 at the First Medical Center of Chinese PLA General Hospital.A total of 41 patients with type 2 diabetes and renal function abnormalities,who were scheduled for renal biopsy,underwent contrast-enhanced ultrasound.Differences in contrast imaging parameters,including time to peak in the renal cortex,peak enhancement,mean transit time local,and area under the curve between diabetic nephropathy and focal segmental glomerulosclerosis were compared,and the correlation between imaging parameters and pathological results was analyzed.Results Among 41 patients,30 cases were diagnosed as diabetic nephropathy,and 11 cases were diagnosed as focal segmental glomerulosclerosis.The peak enhancement and area under the curve in the diabetic nephropathy group were significantly lower than those in the focal segmental glomerulosclerosis group[peak enhancement:3 837.16(2 449.16,5 929.16)vs.8 508.00(4 334.88,21 201.00),Z=-2.766,P=0.006;area under the curve:0.14±0.05 vs.0.19±0.05,t=-3.135,P=0.003].In the diabetic nephropathy group,peak enhancement showed a negative correlation with the global glomerulosclerosis rate(r=-0.489,P=0.006).Conclusion Contrast-enhanced ultrasound can quantitatively evaluate renal perfusion and has certain clinical value in assisting the diagnosis of type 2 diabetic nephropathy.

Micro flow imaging for diagnosing closed liver trauma in pigs / 中国医学影像技术

Objective To observe the value of micro flow imaging(MFI)for diagnosing closed liver trauma in pigs.Methods A self-made impactor was used to impact the liver of 15 healthy pigs under general anesthesia and establish pig models of closed liver trauma.Conventional ultrasound,MFI and contrast-enhanced ultrasound(CEUS)were used to observe the location,extent and degree of liver trauma.Afterwards,the pigs were executed and the livers were removed,and the liver lesions were observed.According gross pathological findings,the diagnostic efficacy of MFI was analyzed.Results Gross pathology showed a total of 29 liver traumas in 15 pigs.The accuracy rate of conventional ultrasound,MFI and CEUS for diagnosing liver trauma in pigs was 37.93％(11/29),82.76％(24/29)and 96.55％(28/29),respectively.Significant difference was found between conventional ultrasound and MFI,also between conventional ultrasound and CEUS(both P＜0.05),but not between MFI and CEUS(P＞0.05).MFI showed no obvious blood flow signal in more than half pig liver trauma sites,while showed"spring like"in 1 pig and scattered blood flow signals in 5 pigs.On CEUS,liver trauma sites in pigs present as low or no perfusion,while"jet like"contrast agent overflow from the liver was noticed in 1 pig and"spring like"contrast agent overflow in 5 pigs,forming liquid dark areas around the liver or in abdominal cavity.Conclusion MFI had certain value for diagnosing closed liver trauma in pigs,hence being comparable to CEUS.

Comparison of the long-term outcomes of focused ultrasound ablation surgery for uterine fibroids and myomectomy / 中华妇产科杂志

Objective:To compare the long-term outcomes after focused ultrasound ablation surgery (FUAS) versus myomectomy for uterine fibroids.Methods:A retrospective study was conducted on women who were treated by FUAS or myomectomy for uterine fibroids at First Medical Center of Chinese PLA General Hospital from January 2007 to January 2015. Regular follow-up was conducted to evaluate the symptoms relief, symptoms recurrence, the need for re-interventions and complications of the two groups.Results:The effective rates were 95.7% (730/763) and 95.5% (1 151/1 205) in women who were treated by FUAS and myomectomy, no statistical difference was seen between the two groups ( χ2 =0.027, P=0.869). The cumulative rates of symptoms recurrence at 1 year, 3 years, 5 years, 8 years and 10 years of follow-up in FUAS group were 1.8%, 6.8%, 11.9%, 15.2% and 15.9%, respectively; and the cumulative re-intervention rates were 0.7%, 4.1%, 6.8%, 9.9% and 11.0%, respectively. The cumulative rates of symptoms recurrence at 1 year, 3 years, 5 years, 8 years and 10 years of follow-up in myomectomy group were 1.8%, 5.9%, 10.6%, 14.2% and 14.9%, respectively; and the cumulative re-intervention rates were 0.9%, 4.5%, 7.8%, 10.3% and 11.4%, respectively. No statistical differences were seen between the two groups (all P>0.05). There were no significant differences in the effective rate, symptoms recurrence rate and re-intervention rate between the two groups in patients with intermural fibroids; but the effective rate of FUAS (95.9%, 235/245) was higher than that of myomectomy (89.1%, 115/129), the symptoms recurrence rate (11.9%, 28/235) was lower than that of myomectomy (27.8%, 32/115), and the re-intervention rate (7.7%, 18/235) was lower than that of myomectomy (17.4%, 20/115) in patients with submucosal fibroids, there were significant different (all P<0.05). The effective rate of FUAS (91.0%, 132/145) was lower than that of myomectomy (97.0%, 322/332), the symptoms recurrence rate (32.6%, 43/132) was higher than that of myomectomy (9.9%, 32/322), and the re-intervention rate (22.0%, 29/132) was higher than that of myomectomy group (6.2%, 20/132) in patients with subserosal fibroids, there were significant different (all P<0.01). The incidences of total [1.8% (14/763) vs 21.9% (264/1 205)], minor and moderate adverse events were lower in FUAS group than myomectomy group (all P<0.001). Conclusion:Satisfaction with long-term outcomes after FUAS treatment or myomectomy for uterine fibroids is comparable.

Research progress of renal resistive index in the evaluation of acute kidney injury / 中华危重病急救医学

Acute kidney injury (AKI) is common in critically ill patients and it is directly related to the patient's prognosis and survival. Despite remaining uncertainties regarding the prevalence of AKI in intensive care unit (ICU), the overall incidence of AKI is relatively high, and prompt recognition is necessary to ensure the risk assessment, early diagnosis, clinical outcome, and treatment of critically ill patients. Doppler-based renal resistive index (RRI) mainly reflects vascular bed resistance state, which can be indirect to the extent of the damage of renal parenchyma. It is a relatively objective and quantitative evaluation, and is widely used in clinical prognosis of acute or chronic renal damage evaluation and judgment. This paper reviews the definition of RRI, the measurement methods of RRI, the application and progress of RRI in the field of AKI, the advantages and disadvantages of ultrasonic measurement of RRI, the long-term application of RRI, the effectiveness of RRI in predicting AKI, and the progress in clinical application.

Clinical value of preoperative perfluorobutane contrast-enhanced ultrasound in the evaluation of microvascular invasion and recurrence of hepatocellular carcinoma / 中华肝胆外科杂志

Objective:To study the use of perfluorobutane contrast-enhanced ultrasound (CEUS) in preoperative detection of microvascular invasion (MVI), and postoperative short-term recurrence of hepatocellular carcinoma (HCC).Methods:Patients who underwent hepatectomy with curative intent at the Chinese PLA General Hospital from January 2021 to April 2021 were prospectively enrolled into this study. Of 42 patients in this study, there were 36 males and 6 females, with age of (56.51±11.95) years old. All patients underwent preoperative perfluorobutane CEUS, and the characteristics of ultrasound, the vascular phase and Kupffer phase of perfluorobutane CEUS were recorded. Based on the pathological results, these patients were divided into the MVI and non-MVI groups. These patients underwent liver MRI once every 3 months postoperatively to diagnose tumor recurrence. According to the recurrence of HCC 6 months after operation, these patients were divided into the non-recurrence and the recurrence groups. Independent risk factors for MVI and short-term recurrence were analyzed by univariate and multivariate analyses.Results:Two patients had two lesions, and the remaining 40 patients had a single lesion. The pathological diagnosis of all the lesions were HCC (14 patients in the MVI group and 28 patients in the non-MVI group). The median follow-up was 6 (3, 6) months, and there were 8 patients in the recurrence group and 34 patients in the non-recurrence group. On logistic analysis, independent risk factors for MVI included the number of vessels detected on color Doppler flow imaging (CDFI) ( OR=5.762, 95% CI: 1.597-20.785, P=0.007), increased tumor size by more than 10% after CEUS arterial enhancement ( OR=10.186, 95% CI: 3.647-28.447, P=0.037), and thickness of corona enhancement at Kupffer phase of greater than 5 mm ( OR=17.340, 95% CI: 6.124-49.095, P=0.040). Cox regression showed the independent risk factors for short-term recurrence to include the number of vessels in CDFI ( RR=7.519, 95% CI: 1.086-52.051, P=0.041) and thickness of corona enhancement at Kupffer phase of greater than 5 mm ( RR=10.623, 95% CI: 1.265-89.218, P=0.030). Conclusion:Preoperative perfluorobutane CEUS had potential values in detecting MVI and in predicting postoperative short-term recurrence of HCC.

Quantitative assessment of left ventricular longitudinal and circumferential strain in elderly patients with acute myocardial infarction using speckle-tracking imaging on echocardiography / 中华老年医学杂志

Objective:To quantitatively evaluate the left ventricular circumferential and longitudinal strain after percutaneous coronary intervention(PCI)in elderly patients with acute myocardial infarction(AMI)using speckle-tracking imaging(STI)on echocardiography.Methods:A prospective case-control study was conducted on 47 elderly patients diagnosed with ST-elevation AMI and undergoing percutaneous coronary interference(PCI)in our hospital from August 2017 to June 2020 as PCI-study group.The 35 normal subjects matched for age and sex were as a normal-control group.The longitudinal peak systolic strain(LPSS)and circumferential peak systolic strain(CPSS)were measured using STI at one week and three months after PCI in the two groups.Results:The values of LPSS and CPSS were apical segment > middle segment > basal segment, which was the similar between LPSS and CPSS.Compared with normal-control group, AMI-PCI group showed that CPSS and LPSS in each segment were significantly reduced at 1 week and 3 months after operation.Compared with the control group, all the CPSS and LPSS values were significantly decreased in AMI group at one week after PCI(-12.3±2.7)% vs.(-22.5±1.7)%( t=19.62, P<0.01); (-12.9±3.2)% vs.(-23.1±2.6)%( t=15.43, P<0.01). Both LPSS and CPSS values were improved at a certain extent at three months after PCI compared with AMI group at one week after PCI.The complete CPSS and LPSS values were significantly increased in AMI group at three months after PCI compared with one week after PCI(-16.8±2.6)% vs.(-12.3±2.7)%, ( t=8.23, P<0.01); (-17.0±3.3)% vs.(-12.9±3.2)%( t=6.11, P<0.01). But, there were still significant differences compared with the NC group(-16.8±2.6)% vs.(-22.5±1.7)%( t=11.29, P<0.01); (-17.0±3.3)% vs.(-23.1±2.6)%( t=9.04, P<0.01). Conclusions:The longitudinal and circumferential strain of left ventricle were severely damaged in elderly patients with AMI.The speckle-tracking imaging technique can be used to quantitatively evaluate the left ventricular strain and its improved situation after PCI in elderly AMI patients.

Comparative study on the diagnostic value of multiparametric transrectal ultrasound and multiparametric MRI in prostate cancer / 中华泌尿外科杂志

Objective The aim of the study is to compare the diagnostic value of multiparametric transrectal ultrasound(TRUS) and multiparametric magnetic resonance imaging (MRI) in prostate cancer.Methods The clinical data of 102 patients who received multiparametric TRUS (including conventional transrectal ultrasound,shear wave sonoelastography and contrast enhanced ultrasound),multiparametric MRI (including T2 weighted diffusion weighted,and dynamic contrast enhanced MRI) and laboratory tests from April 2016 to May 2018 were retrospectively analyzed.The average age was 66.1 years old,ranging 38.0-85.0 years old.The average PSA was 30.1 ng/ml,ranging 0.4-227.0 ng/ml.The average PSAD was 0.67 ng/ml2,ranging 0.02-4.27 ng/ml2.The pathology results from TRUS guided biopsy or surgical operation were chosen as gold standard.Diagnostic performance including sensitivity,specificity,positive predictive value (PPV),negative predictive value (NPV),accuracy and area under the receiver operating characteristic curve (AUROC) of multiparametric TRUS and multiparametric MRI in prostate cancer were analyzed.Results There were 62 prostate cancer and 40 BPH patients in our study.Parallel multiparametric TRUS diagnosed 63 prostate cancer and 39 BPH,and multiparametric MRI diagnosed 75 prostate cancer and 27 BPH.The sensitivity,specificity and accuracy of parallel multiparametric TRUS were 98.4％,70.0％ and 87.3％,respectively.And those of multiparametric MRI were 95.2％,60.0％ and 81.4％,respectively.The AUROC of parallel multiparametric TRUS and multiparametric MRI were 0.842 and 0.776,with no significant differences (P =0.208).Conclusion The diagnostic value of multiparametrie TRUS was not inferior to multiparametrie MRI in prostate cancer.

Anhydrous Ethanol Improves Efficiency of Radiofrequency Ablation for the Treatment of Benign Thyroid Nodules:A Prospective Randomized Controlled Trial / 中国医学科学院学报

To investigate the value of injecting a small amount of absolute ethanol into the benign solid nodules of the thyroid before radiofrequency ablation(RFA)to improve the efficiency of radiofrequency ablation. A total of 98 eligible patients(98 nodules)with pathologically confirmed benign solid nodules who were treated in our center from December 2016 to February 2018 were included and randomized into ethanol ablation(EA)combined with radiofrequency ablation(RFA)group(EA+RFA group)and RFA group,with 49 patients in each group.Routine ultrasound,contrast-enhanced ultrasound(CEUS),and thyroid function test were performed before treatment and 1,3,6,and 12 months after treatment.The general information,treatment time,ablation energy,ablation power,postoperative nodule volume reduction ratio(VRR),symptom score(SS)and cosmetic score(CS),thyroid function level,and incidence of complications were compared between these two groups. The mean treatment time [(441.30±243.31)s (790.70±349.82)s;= 4.403, =0.000],mean ablation energy [(3.92±2.01)kJ (5.15±2.12)kJ;=2.709, =0.009],and mean ablation power [(6.07±1.44)W (7.30±1.29)W;=3.612, =0.006] were significantly lower in the EA+RFA group than in the RFA group.At 3,6 and 12 months after surgery,the VRR in the EA+RFA group was(57.73±11.07)%(=-3.16, <0.001),(64.40±10.56)%(=-5.45, <0.001),and(77.29±8.48)%(=-10.46, <0.001),respectively;the VRR in the RFA group was(55.44±13.01)%(=-1.76, <0.001),(65.28±11.33)%(=-5.09, <0.001),and(75.17±9.84)%(=-8.93, <0.001),which were significantly smaller than those before surgery.There was no significant difference in VRR between the EA+RFA group and the RFA group at 1(=3.41, =0.33),3(=2.05, =0.21),6(=2.77, =0.49),and 12 months(=5.05, =0.10)after treatment.During the follow-up,no recurrence of nodules was observed on CEUS.In the EA+RFA group,the SS [(1.77±0.86).(5.54±2.15);=9.63, <0.001] and the CS[(1.39±0.77).(3.32±0.61);=10.09, =0.004]at 12 months after surgery were significantly lower than those before surgery.In the RFA group,SS [(1.63±1.04).(5.90±1.79);=12.72, <0.001] and CS [(1.64±0.83).(3.15±0.72);=8.13, =0.012] at 12 months after surgery were also significantly lower than those before surgery.The CSS in the EA+RFA group was significantly lower than that in the RFA group [(0.93±0.55).(2.44±0.53);=-11.70, =0.007].Both groups had no significant change in thyroid function during the follow-up period,and no serious complications were observed. Anhydrous alcohol injection can effectively improve the efficiency of radiofrequency ablation in treating benign solid thyroid nodules and is effective in reducing nodule volume,alleviating compressive symptoms,and decreasing cosmetic discomfort.

Comparative study on the diagnostic value of multiparametric transrectal ultrasound and multiparametric MRI in prostate cancer / 中华泌尿外科杂志

Objective@#The aim of the study is to compare the diagnostic value of multiparametric transrectal ultrasound(TRUS) and multiparametric magnetic resonance imaging (MRI) in prostate cancer.@*Methods@#The clinical data of 102 patients who received multiparametric TRUS (including conventional transrectal ultrasound, shear wave sonoelastography and contrast enhanced ultrasound), multiparametric MRI(including T2 weighted diffusion weighted, and dynamic contrast enhanced MRI) and laboratory tests from April 2016 to May 2018 were retrospectively analyzed. The average age was 66.1 years old, ranging 38.0-85.0 years old. The average PSA was 30.1 ng/ml, ranging 0.4-227.0 ng/ml. The average PSAD was 0.67 ng/ml2, ranging 0.02-4.27 ng/ml2. The pathology results from TRUS guided biopsy or surgical operation were chosen as gold standard. Diagnostic performance including sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV), accuracy and area under the receiver operating characteristic curve(AUROC)of multiparametric TRUS and multiparametric MRI in prostate cancer were analyzed.@*Results@#There were 62 prostate cancer and 40 BPH patients in our study. Parallel multiparametric TRUS diagnosed 63 prostate cancer and 39 BPH, and multiparametric MRI diagnosed 75 prostate cancer and 27 BPH. The sensitivity, specificity and accuracy of parallel multiparametric TRUS were 98.4%, 70.0% and 87.3%, respectively. And those of multiparametric MRI were 95.2%, 60.0% and 81.4%, respectively. The AUROC of parallel multiparametric TRUS and multiparametric MRI were 0.842 and 0.776, with no significant differences(P=0.208).@*Conclusion@#The diagnostic value of multiparametric TRUS was not inferior to multiparametric MRI in prostate cancer.

Contrast-enhanced ultrasound in the evaluation of thickened wall type of gallbladder carcinoma / 中华医学超声杂志（电子版）

Objective To investigate the contrast enhanced ultrasound (CEUS) characteristics of thickened wall type of gallbladder carcinoma and to evaluate their diagnostic value. Methods The CEUS images, clinical information and pathological results of 26 patients with thickened wall type of gallbladder carcinoma and 37 patients having benign gallbladder disease with thickened wall were retrospectively analyzed. CEUS characteristics of thickened wall type of gallbladder carcinoma were investigated and their diagnostic value was evaluated. The age, length of gallbladder, width and thickness of gallbladder wall were analyzed by t test. The CEUS characteristics of gallbladder wall (intensity of gallbladder wall, mucosal morphology and submucosal hypo-enhancement area)were analyzed by χ2 test.The diagnostic test used ROC (receiver operating characteristic) curve to calculate sensitivity, specificity, positive predictive value, negative predictive value and accuracy. Results The gallbladder wall thickness and patient age in malignant group were all larger than those in benign group[(1.63±0.68)cm vs(0.96±0.55)cm,(63.7±10.1)years old vs (53.2±11.8) years old], with statistically significant difference (t=3.70, 4.32, all P<0.001). In the malignant group, CEUS showed irregular mucosal, hyper-enhancement and sub-mucosal hypo-enhancement area, with statistically significant difference(χ2=48.7,42.9,23.8,OR=9.25,6.17,2.47,all P < 0.001).The sensitivity of irregular mucosa, hyper-enhancement and sub-mucosal hypo-enhancement area were all 100.0%, and their accuracy were 93.7%, 90.5% and 76.2% respectively. If lesions with both irregular mucosa and hyper-enhancement were diagnosed as thickened wall type of gallbladder carcinoma, the diagnostic accuracy could be further improved to 98.4%. Conclusion CEUS can facilitate the differential diagnosis of benign and malignant gallbladder diseases with thickened wall in a high diagnostic value.

Pilot clinical study on predicting nature of gallbladder polyp by measuring sizes in different directions, stalk width with gray scale ultrasound and contrast-enhanced ultrasound / 中华医学超声杂志（电子版）

Objective To evaluate clinical application of measuring the sizes in different directions and stalk width of gallbladder polyp lesions (GPL) ≥1.0 cm for differentiation diagnosis between cholesterol polyp and adenoma by both gray scale ultrasound (US) and contrast-enhanced ultrasound (CEUS). Methods From January to September 2016, a total of 81 patients with GPL ≥ 1.0 cm received cholecystectomy in our hospital were enrolled in this study. All participations underwent US and CEUS scanning before cholecystecomy. Patient′s clinical data, sizes in different directions, stalk width and features of US images were recorded. According to pathological findings, patients were divided into cholesterol polyp group and adenoma group. All of the clinical data, sizes, stalk width and features of US images were statistically analyzed. Patient′s age, size in vertical and parallel sizes, stalk width of GPL, ratio of vertical size to stalk width, ratio of parallel size to stalk width and ratio of vertical size to parallel size were compared with t-test. Genda, number and location of GPL, echoic level and blood flow signal were compared with the χ2test.Bivariate was used for relation analysis.Results There were difference in patient′s age,vasularity of GPL, size in vertical direction, size in parallel direction, stalk width, ratio of vertical size to stalk width, ratio of parallel size to stalk width[9(15.8%)vs 9(37.5%),(37.02±10.14)years old vs(52.25±13.85)years old, (0.94±0.33)cm vs(1.27±0.79)cm,1.10±0.37 vs 1.71±0.50,(0.26±0.10)cm vs(0.58±0.51)cm,3.82±1.87 vs 2.92±1.61],the differences were statistically significant(χ2=2.675,t=5.303,2.675,5.855,4.566,-2.536, all P<0.05), but no difference in ration of vertical size to parallel size between two groups (all P>0.05). Bivariate realtion analysis proved that size in vertical direction, size in parallel direction, stalk width and ratio of vertical size to stalk width were related with the nature of GPL≥1.0 cm (r=0.375, 0.571, 0.586, -0.342, all P<0.05). Conclusion Sizes in different directions and stalk width were important factors for predicting the nature of GPL ≥1.0 cm.

The effect and influencing factors of percutaneous radiofrequency ablation for the treatment of benign thyroid nodules / 中华医学超声杂志（电子版）

Objective To explore the curative effect and influencing factors of percutaneous radiofrequency ablation(PRFA)for benign thyroid nodules in order to improve the effect of thyroid benign nodule ablation treatment.Methods The study included 482 benign thyroid nodules.The largest diameter of benign thyroid nodules ranges from 0.7 to 9.2 cm.Two hundred and fifty-eight nodules were solid nodules,224 nodules were cystic-solid nodules,and 96 thyroid nodules combined with the background of Hashimoto's thyroiditis.The patients of this study included 356 females and 126 males,the ages of the study population ranged from 14 to 82 years old.In order to observe the local pain,swelling,skin infection,hoarseness and other complications of the thyroid nodules with PRFA,we conducted conventional ultrasound and contrast-enhanced ultrasound immediately and followed up in 1,3,6,12,18 and 24 months after the treatment.Besides,the nodule volume reduction ratio was calculated,and the effects of gender,age,nodule size,cystic proportion,and the background of Hashimoto's thyroiditis on the treatment were analyzed.Results The volume of benign thyroid nodules after the PRFA treatment was significantly reduced after 1,3,6,12,18,24 months,and their nodule volume reduction ratio(VRR)was(51.2±5.7)%(1 months),(69.7±4.3)%(3 months),(84.6±3.7)%(6 months),(89.3±2.9)%(12 months),(93.7±1.6)%(18 months)and(94.9±1.4)%(24 months),respectively.The thyroid nodules were divided into 3 groups according to the cystic portion,significant differences were found in the volume reduction rate at 1,3,6,12,18 and 24 months after PRFA(F=66.858,69.101,19.410,49.559,146.653 and 309.950 respectively,all P＜0.001),the more cystic portion was,the faster the lesion shrinked.The nodules with the cystic portion ＜ 20%were grouped according to the maximum diameter(≤3 cm/＞3 cm),and the background of Hashimoto's disease; and significant differences were found in the volume reduction rate at 1,3,6,12,18 and 24 months after PRFA(the t values for different size groups were 9.710,8.925,9.899,12.734,17.226 and 42.580,respectively,the t values for whether there is a background of Hashimoto's disease were 66.858,69.101,19.410,49.559,146.653,309.950,respectively,all P ＜ 0.001).The VRR of nodules of which the maximum diameter ≤ 3 cm,or without Hashimoto's thyroiditis was larger after radiofrequency ablation.The nodules of which the maximum diameter≤3 cm and with the cystic portion ＜20%were grouped according to different genders(male or female)and different ages(≤40 or＞40 years old),and the mean VRR of the nodules between different gender and age groups are not significantly different(P＞0.05).Conclusions Ultrasound guided PRFA is a safe and effective minimally invasive therapy for benign thyroid nodules.

Protection Provided by a Gabexate Mesylate Thermo-Sensitive In Situ Gel for Rats with Grade III Pancreatic Trauma

BACKGROUND/AIMS: This study investigated the protection provided by gabexate mesylate thermo-sensitive in-situ gel (GMTI) against grade III pancreatic trauma in rats. METHODS: A grade III pancreatic trauma model with main pancreatic duct dividing was established, and the pancreas anatomical diagram, ascites, and serum biochemical indices, including amylase, lipase, C-reactive protein (CRP), interleukin 6 (IL-6), and tumor necrosis factor-α (TNF-α), were examined. The pancreas was sliced and stained with hematoxylin eosin and subjected to terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining. RESULTS: Ascites, serum amylase, lipase, CRP, IL-6, and TNF-α levels were significantly increased in the pancreas trauma (PT) groups with prolonged trauma time and were significantly decreased after GMTI treatment. The morphological structure of the pancreas was loose, the acinus was significantly damaged, the nuclei were irregular and hyperchromatic, and there was inflammatory cell invasion in the PT group compared to the control. After GMTI treatment, the morphological structure of the pancreas was restored, and the damaged acinus and inflammatory cell invasion were decreased compared to the PT group. Moreover, the cell apoptosis index was significantly increased in the PT group and restored to the same levels as the control group after GMTI treatment. CONCLUSIONS: GMTI, a novel formulation and drug delivery method, exhibited specific effective protection against PT with acute pancreatitis therapy and has potential value as a minimally invasive adjuvant therapy for PT with acute pancreatitis.

Preliminary Study on Quantitative Evaluation of Hardness of Gastrocnemius and Soleus Using Shear-wave Ultrasound Elastography / 中国医学影像学杂志

Purpose To explore the effect of ultrasonic section,patient position and other factors on Young's modulus and shear wave velocity measurement of the muscle,and to study the consistency between Young's modulus and shear wave velocity on reflection of muscle hardness.Materials and Methods Shear wave elastography was used to detect 10 healthy young men and 10 women.Longitudinal and transverse detection of the Young's modulus and shear wave velocity of gastrocnemius and soleus were performed in natural ankle joint position,maximum plantar flexion and maximum dorsiflexion position.Results ① Comparison of the elasticity measurement between gastrocnemius and soleus.There were significant differences in the Young's modulus in the maximum plantar flexion and Young's modulus and shear wave velocity in maximum dorsiflexion position in longitudinal detection (P＜0.05) that gastrocnemius measurements were higher than soleus measurements.There were significant differences in Young's modulus and the shear wave velocity (P＜0.05) in natural position and maximum dorsiflexion position that soleus measurements were higher than gastrocnemius measurements.② In the positions of the ankle joints,the differences between longitudinal detection values and transverse detection values of gastrocnemius or soleus were statistically significant (P＜0.01) and longitudinal detection values were higher than transverse detection values.③ Comparison of the elasticity measurement of gastrocnemius and soleus muscle among different positions of the ankle joints.The measurement in natural position and in the maximum plantar flexion were evidently higher than that in the maximum dorsiflexion position (P＜0.01) in longitudinal detection.The maximum dorsiflexion position showed higher elasticity measurement.Only elasticity measurement in natural position and the maximum plantar flexion of the soleus was statistically different from that in the maximum dorsiflexion position (P＜0.01) that it was higher in the maximum dorsiflexion position.Conclusion The ultrasound elasticity measurements of gastrocnemius and soleus are related with the ultrasonic longitudinal or transverse section and the relative ankle positions.Moreover,there are some differences in elasticity measurements between these two muscles.should be given to all of these in quantitative evaluation of muscle hardness using shear wave ultrasound elastography.

The correlation of contrast-enhanced ultrasound vascular mode with gallbladder polyp nature and size / 中华医学超声杂志（电子版）

Objective To evaluate the correlation between enhancement vascular mode and gallbladder polyp nature and size with contrast-enhance ultrasound (CEUS).Methods From December 2014 to May 2016,patients with gallbladder polyp lesions (GPL) larger than 1.0 cm were enrolled in this study.Before cholecystectomy,every patient underwent ultrasound (US) and CEUS examination.All features of US and CEUS were analyzed by two doctors who were blind to the patient clinical data.According to the pathological findings,GPL were divided into cholesterol polyp group and gallbladder adenoma group.The US features and enhancement vascular mode were analyzed statistically by t test and x2 test.The independent risk factors were analyzed by Logistic regression.The relationship between enhancement vascular mod and size of GPL were determined by bivariate correlation analysis.Results There were 103 patients with GPL larger than 1.0 cm.Eighty-two cases were cholesterol polyp and 21 cases were gallbladder adenoma.There were differences in size and color Doppler blood flow between two groups (t=-5.97 and 7.94,P ＜ 0.05).Dotted,branched vascular mod and irregular vascular mode were statistical different between two groups (x2=10.09 and 8.43,P ＜ 0.05).Regression analysis data proved that the size and branch vascular mod were the independent risk factors related with adenoma (P ＜ 0.05).In both cholesterol polyp group and adenoma group,there were weak positive correlation between enhancement vascular mode and size of GPL (r=0.188,0.397,P ＜ 0.05).Conclusions Branch vascular mod and size of GPL were help to distinguish gallbladder adenoma from cholesterol polyp.Comprehensive analysis of GPL's size and vascular mode could offer important guidance for differentiation diagnosis.

The diagnostic value of thyroid rich blood supply lesions by using contrast-enhanced ultrasound / 中华医学超声杂志（电子版）

Objective To investigate the differential diagnostic value for thyroid rich blood supply lesions by contrast-enhanced ultrasound (CEUS).Methods From February 2016 to January 2015,patients who suffered with thyroid nodules underwent conventional ultrasound and CEUS before biopsy.Sixty-two lesions with high-enhancement features were included in the final data.The enhancement patterns within and around lesions of CEUS were analyzed,and the high-enhancement ranges were compared with lesions sizes displayed on conventional ultrasound imaging.When pathology was regarded as the golden standard,39 nodules of 62 were benign,and 23 were malignant.The difference of CEUS characteristics between benign and malignant lesion was compared using x2 test.Results The homogeneity or not had significant difference between benign and malignant lesions with high-enhancement features (x2=9.78,P=0.002).The features of high-enhancement with cystic area and uneven distribution of high-enhancement area had significant difference between benign and malignant lesions (x2=10.77,P=0.001),and the former were frequently seen in benign lesions.Peripheral regular and irregular rings had significant difference between the benign and malignant lesions (x2=24.33,P ＜ 0.001).All lesions showed large high-enhancement area were malignant (x2=6.52,P=0.01).The diagnostic sensitivity,specificity and accuracy of CEUS were 95.83％,78.95％ and 85.48％ for thyroid rich blood supply lesions,which were better than those of conventional ultrasound (87.5％,68.42％,75.81％).Conclusions There are different features in CEUS between the benign and malignant thyroid lesions with rich blood supply.Heterogeneous high-enhancement,peripheral irregular rings and extensive high-enhancement area were malignant features.

Correlation between ultrasonographic features of thyroid nodules and BRAFV600Emutation / 中华医学超声杂志（电子版）

Objective To study the correlation between ultrasonographic features of thyroid nodule and BRAFV600Emutation. Methods A total of 179 patients with 194 suspicious throid nodules were included in this study. They underwent ultrasound, biopsy, pathology and BRAFV600Emutation examination between October 2015 and February 2016 at Chinese PLA General Hospital. The size of nodules were (1.1±0.8) cm. The size, echo, boundary, shape aspect ratio, calcification and capsular invasion of nodules were investigated. The correlation between ultrasonographic features of thyroid nodule and BRAFV600Emutation analyzed by chis-square test and Logistic Regression analysis using statistical data as independent variable, BRAFV600Emutation as dependent variable. Results There were significant different in nodule′s ratio, boundary, capsular invasion characteristic between the BRAFV600Epositive group and the BRAFV600Enegative group(χ2=11.174,45.517,11.046,all P < 0.05),and these signs are possibly associated with BRAFV600Emutation by logistic regression model analysis(OR=2.276,95%CI:1.117-4.638, P < 0.05; OR=8.412, 95%CI: 3.836-18.448,P < 0.001; OR=2.582, 95%CI: 1.138-5.860,P < 0.05). Conclusions The ratio, boundary, capsular invasion characteristic of thyroid nodules are possibly associated with BRAFV600Emutation. These signs can be used to predict BRAFV600Emutation and facilitate subsequent treatment for such nodules.

Value of Contrast-enhanced Ultrasound and Conventional Ultrasound in the Diagnosis of Papillary Thyroid Carcinoma with Cervical Lymph Node Metastases / 中国医学科学院学报

Objective To compare the ultrasound features of papillary thyroid carcinoma with or without cervical lymph node metastasis (LNM). Methods Patients suspected of thyroid cancer underwent the conventional ultrasound and contrast-enhanced ultrasound (CEUS) examinations. Patients' age,sex,and ultrasound characteristics of lesions were recorded. With the surgical pathology as the golden standard,the ultrasound features were compared between the cervical LNM group and non-LNM group. Results Of 144 patients,51 had cervical LNM and 93 did not. Patients' ages,sex and number of lesions had no significant difference between two groups (all P>0.05). Tumor with LNM had maximum size greater than 0.85 cm,ill-defined margin (P=0.000),irregular shape (P=0.007),internal heterogeneous echogenicity (P=0.007),microcalcification (P=0.020),internal heterogeneous low-enhancement (P=0.002),peripheral non-enhancement ring (P=0.030),and extracapsular extension (P=0.000). Conclusion Conventional ultrasound and CEUS are helpful for predicting the cervical LNM of PTC. CEUS can obtain more accurate diagnostic results for the extracapsular extension,which contributes to the prediction of cervical LNM.