Research progress in micro/nanobubbles for ultrasound diagnosis or treatment / 药学学报

In the past few decades, microbubbles were widely used as ultrasound contrast agents in the field of tumor imaging. With the development of research, ultrasound targeted microbubble destruction technology combined with drug-loaded microbubbles can achieve precise drug release and play a therapeutic role. As a micron-scale carrier, microbubbles are difficult to penetrate the endothelial cell space of tumors, and nano-scale drug delivery system—nanobubbles came into being. The structure of the two is similar, but the difference in size highlights the unique advantages of nanobubbles in drug delivery. Based on the classification principle of shell materials, this review summarized micro/nanobubbles used for ultrasound diagnosis or treatment and discussed the possible development directions, providing references for the subsequent development.

Diagnostic value of ultrasound contrast agent enema in patients with anastomotic leakage after rectal cancer resection / 中华超声影像学杂志

Objective:To investigate the diagnostic value of ultrasound contrast agent enema (UCAE) for anastomotic leakage (AL) after rectal cancer surgery.Methods:From January 2020 to December 2022, a total of 95 patients with presacral fluid collection after rectal cancer surgery in the Sixth Affiliated Hospital of Sun Yat-sen University who received perineal ultrasound (PNUS) and UCAE were retrospectively selected. Among them, 70 patients (73.3%) were diagnosed with AL.After PNUS scanning, all patients received a diluted ultrasound contrast agent administered through the rectum. Receiver operating characteristic (ROC) curve were used to compare the accuracies of PNUS, UCAE, CT, MRI and water-soluble contrast enema in the diagnosis of AL. Factors that may have impacts on the sensitivity of UCAE were thoroughly analyzed.Results:UCAE improved the consistency (Kappa value: 0.757 vs 0.292, P<0.001) and accuracy (AUC: 0.893 vs 0.693, P<0.001) of PNUS in the diagnosis of AL, and its diagnostic accuracy was comparable to that of CT (AUC 0.807), MRI (AUC 0.811) and water-soluble contrast enema (AUC 0.923) (all P>0.05). For mid-to-high AL (anastomotic stoma distance ≥70 mm) and tiny AL (≤3 mm), the sensitivity of UCAE decreased significantly (anastomotic stoma position: 25.0% vs 85.5%, P=0.001; anastomotic leak diameter: 42.9% vs 87.5%, P=0.002). Conclusions:UCAE can significantly improve the diagnostic accuracy and consistency of PNUS for AL after rectal cancer surgery, and its diagnostic sensitivity is affected by the anastomotic stoma distance and the diameter of the leak.

Advantages of contrast-enhanced ultrasound in the localization and diagnostics of sentinel lymph nodes in breast cancer / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Sentinel lymph nodes (SLNs) are the first station of lymph nodes that extend from the breast tumor to the axillary lymphatic drainage. The pathological status of these LNs can predict that of the entire axillary lymph node. Therefore, the accurate identification of SLNs is necessary for sentinel lymph node biopsy (SLNB) to replace axillary lymph node dissection (ALND). The quality of life and prognosis of breast cancer patients are related to proper surgical treatment after the precise identification of SLNs. Some of the SLN tracers that have been identified include radioisotope, nano-carbon, indocyanine green (ICG), and methylene blue (MB). However, these tracers have certain limitations, such as pigmentation, radiation dangers, and the requirement for costly detection equipment. Ultrasound contrast agents (UCAs) have good specificity and sensitivity, and thus can compensate for some shortcomings of the mentioned tracers. This technique is also being applied to SLNB in patients with breast cancer, and can even provide an initial judgment on SLN status. Contrast-enhanced ultrasound (CEUS) has the advantages of high distinguishability, simple operation, no radiation harm, low cost, and accurate localization; therefore, it is expected to replace the traditional biopsy methods. In addition, it can significantly enhance the accuracy of SLN localization and shorten the operation time.

Experimental study on high-frequency subharmonic scattering characteristics of ultrasound contrast agent microbubbles under low ambient pressure / 生物医学工程学杂志

Correlation between nonlinear subharmonic scattering of ultrasound contrast agent microbubbles and ambient pressure is expected to be used for local brain tissue pressure monitoring. Although high-frequency ultrasound has achieved high-resolution imaging of intracranial microvessels, the research on high-frequency subharmonic scattering characteristics of microbubbles is insufficient at present, which restricts the research progress of estimating local brain tissue pressure based on high-frequency subharmonic scattering of microbubbles. Therefore, under the excitation of 10 MHz high-frequency ultrasound, the effects of different acoustic pressures and ambient pressures on the high-frequency subharmonic scattering characteristics of three different ultrasound contrast agents including SonoVue, Sonazoid and Huashengxian were investigated in this in vitro study. Results showed that the subharmonic scattering amplitudes of the three microbubbles increased with the increase of ambient pressure at the peak negative acoustic pressures of 696, 766 and 817 kPa, and there was a favorable linear correlation between subharmonic amplitude and ambient pressure. Under the above three acoustic pressures, the highest correlation coefficient of SonoVue was 0.948 ( P = 0.03), the highest sensitivity of pressure measurement was 0.248 dB/mm Hg and the minimum root mean square error (RMSE) was 2.64 mm Hg. Sonazoid's highest correlation coefficient was 0.982 ( P < 0.01), the highest sensitivity of pressure measurement was 0.052 dB/mm Hg and the minimum RMSE was 1.51 mm Hg. The highest correlation coefficient of Huashengxian was 0.969 ( P = 0.02), the highest sensitivity of pressure measurement was 0.098 dB/mm Hg and the minimum RMSE was 2.00 mm Hg. The above in vitro experimental results indicate that by selecting ultrasound contrast agent microbubbles and optimizing acoustic pressure, the correlation between high-frequency subharmonic scattering of microbubbles and ambient pressure can be improved, the sensitivity of pressure measurement can be upgraded, and the measurement error can be reduced to meet the clinical demand for local brain tissue pressure measurement, which provided an important experimental basis for subsequent research in vivo.

A new method for isolating gas vesicles from Microcystis for ultrasound contrast / 生物工程学报

Gas vesicles are a unique class of gas-filled protein nanostructures which are commonly found in cyanobacteria and Halobacterium. The gas vesicles may scatter sound waves and generate harmonic signals, which enabled them to have the potential to become a novel ultrasound contrast agent. However, the current hypertonic cracking method for isolating gas vesicles contains tedious operational procedures and is of low yield, thus not suitable for large-scale application. To overcome these technical challenges, we developed a rapid and efficient method for isolating gas vesicles from Microcystis. The new H2O2-based method increased the yield by three times and shortened the operation time from 24 hours to 7 hours. The H2O2 method is not only suitable for isolation of gas vesicles from laboratory-cultured Microcystis, but also suitable for colonial Microcystis covered with gelatinous sheath. The gas vesicles isolated by H2O2 method showed good performance in ultrasound contrast imaging. In conclusion, this new method shows great potential for large-scale application due to its high efficiency and wide adaptability, and provides technical support for developing gas vesicles into a biosynthetic ultrasonic contrast agent.

Research Progress of Targeted Ultrasound Contrast Agent BR55 / 中国医学科学院学报

BR55 is an ultrasound contrast agent targeting vascular endothelial growth factor receptor 2,which can be used to detect tumor neovascularization and improve the diagnostic accuracy.Overseas researchers have used BR55 for human ultrasound molecular imaging,which showed good safety and tolerance.We reviewed the research progress on BR55 applied in the evaluation of tumor neovascularization from the composition,characteristics,animal experiments,and clinical studies of BR55.

Experimental studies for noninvasive assessment of portal vein pressure based on contrast enhanced subharmonic sonographic imaging / 生物医学工程学杂志

Portal hypertension (PHT) is a common complication of liver cirrhosis, which could be measured by the means of portal vein pressure (PVP). However, there is no report about an effective and reliable way to achieve noninvasive assessment of PVP so far. In this study, firstly, we collected ultrasound images and echo signals of different ultrasound contrast agent (UCA) concentrations and different pressure ranges in a low-pressure environment based on an

Site‐targeted imaging enhancement of viable myocardium after ischemia‐reperfusion by a novel nano‐scale ultrasound contrast agent :a vivo study / 中华超声影像学杂志

Objective To prepare a kind of lipid nanoparticle ultrasound contrast agents with the ability to target to viable myocardium for diagnosis . Methods T he agent was a biotinylated ,fluorescent‐labelled ,lipid‐coated , liquid perfluorocarbon emulsion . Physico‐chemical properties of the agent were measured ,including size distribution ,Zeta Potential ,concentration and so on . Ischemia‐reperfusion models were created in rats ,and then exposed to biotinylated anti‐MCP‐1 monoclonal antibody ,rhodamine avidin and biotinylated ,FITC‐labelled nanoparticles ,respectively . Echocardiography was taken before and after injection . Frozen sections of their hearts were observed under fluorescence microscope . Results T he particle diameter ,zeta potential and concentration of lipid nanoparticles were ( 172 .30 ± 52 .06) nm ,( －33 .10 ± 6 .50) mV and ( 2 .28 ± 0 .46 ) × 1011/ml ,respectively . From the short‐axis view ,the myocardium under endocardium of anterior wall was enhanced obviously . While myocardium of other walls were still . T he lipid nanoparticles located in the myocardium of anterior wall and gave out bright green and red fluorescence under fluorescence microscope ,w hile neither lipid nanoparticles nor fluorescence were found in other sites of ventricular myocardium . Conclusions The viable myocardium can be targeted and acoustically enhanced by the self‐made nano‐scale ultrasound contrast agent . T his new agent has potential to improve sensitivity and specificity for noninvasive identifying viable myocardium .

Site-targeted imaging enhancement of viable myocardium after ischemia-reperfusion by a novel nano-scale ultrasound contrast agent: a vivo study / 中华超声影像学杂志

Objective@#To prepare a kind of lipid nanoparticle ultrasound contrast agents with the ability to target to viable myocardium for diagnosis.@*Methods@#The agent was a biotinylated, fluorescent-labelled, lipid-coated, liquid perfluorocarbon emulsion. Physico-chemical properties of the agent were measured, including size distribution, Zeta Potential, concentration and so on. Ischemia-reperfusion models were created in rats, and then exposed to biotinylated anti-MCP-1 monoclonal antibody, rhodamine avidin and biotinylated, FITC-labelled nanoparticles, respectively. Echocardiography was taken before and after injection. Frozen sections of their hearts were observed under fluorescence microscope.@*Results@#The particle diameter, zeta potential and concentration of lipid nanoparticles were (172.30±52.06)nm, (-33.10±6.50)mV and (2.28±0.46)×1011/ml, respectively. From the short-axis view, the myocardium under endocardium of anterior wall was enhanced obviously. While myocardium of other walls were still. The lipid nanoparticles located in the myocardium of anterior wall and gave out bright green and red fluorescence under fluorescence microscope, while neither lipid nanoparticles nor fluorescence were found in other sites of ventricular myocardium.@*Conclusions@#The viable myocardium can be targeted and acoustically enhanced by the self-made nano-scale ultrasound contrast agent. This new agent has potential to improve sensitivity and specificity for noninvasive identifying viable myocardium.

Three-dimensional echocardiography combined with myocardial contrast echocardiography for assessment of myocardial dysfunction in patients with type 2 diabetes mellitus / 中国医学影像技术

Objective: To explore the value of real-time three-dimensional echocardiography (RT-3DE) combined with myocardial contrast echocardiography (MCE) in evaluating myocardial dysfunction in type 2 diabetes mellitus (T2DM) patients. Methods: Totally 58 T2DM patients were divided into group (T2DM isolated ) and group Ⅱ (T2DM associated with microvascular complications, each n=29). Group C included 32 normal individuals. The standard deviation (Tmsv16-SD, Tmsv12-SD, Tmsv6-SD) and the maximum time difference (Tmsv16-Dif, Tmsv12-Dif, Tmsv6-Dif) of the time to the minimum systolic volume of left ventricle were measured with RT-3DE. MCE was performed to obtain perfusion measurement of each segment of ventricular wall, including the acoustic intensity (A), microvascular flow velocity (β) and A•β. Results: There were statistically significant differences in all synchronize measurements except Tmsv6-Dif between group Ⅱ and group C (all P0.05). Conclusion: Left ventricular desynchrony can be observed in T2DM patients with or without microvascular complications. Myocardial perfusion reduce in T2DM patients presenting as diffuse damage, which aggravated with microvascular complications in other organs.

Comparison analysis of clinical and contrast-enhanced ultrasound characteristics of hepatic angiomyolipoma compared with hepatic cavernous hemangioma and hepatocellular carcinoma / 中国医学影像技术

Objective: To compare clinical features and ultrasonic characteristics of hepatic angiomyolipoma (HAML), hepatic cavernous hemangioma (HCH) and hepatocellular carcinoma (HCC). Methods: Data of 40 patients with HAML confirmed by pathology who underwent CEUS were retrospectively analyzed. Clinical features, imaging characteristics of conventional ultrasound and CEUS were observed. Mean while, 40 patients with HCH and 40 patients with HCC were enrolled for comparison with HAML. Results: HAML mainly occurred in female (70.00%, 28/40), with an average age of (39.8±10.6) years. Distinctions of gender, age and hepatitis virus infection were statistically significant between HAML and HCC (all P0.05). HAML mostly presented as high echogenic lesions with clear boundaries and regular morphology on conventional ultrasound. There was no significant difference lesions'number, size, morphology nor blood supply between HAML and HCC (all P>0.05), but the distinctions of echo (χ2=8.93, P=0.008) and boundary (χ2=2.03, P=0.013) were statistically different. No statistical difference of number, size, border, echo, lesion morphology and blood supply was found between HAML and HCH (all P>0.05). On CEUS, 62.50% (25/40) of HAML showed "fast in and fast out" performance, but it subsided into iso-enhancement (t=-2.46, P=0.016) or hypo-enhancement (t=-5.35, P0.05). Conclusion: Combination of clinical features, conventional ultrasound and CEUS characteristics are helpful to distinguish HAML from HCH and HCC.

Contrast-enhanced ultrasound of hepatocellular carcinoma: where do we stand?

Contrast-enhanced ultrasound (CEUS) represents a significant breakthrough in ultrasonography (US), and it is being increasingly used for the evaluation of focal liver lesions (FLLs). CEUS is unique in that it allows non-invasive assessment of liver perfusion in real time throughout the vascular phase, which has led to dramatic improvements in the diagnostic accuracy of US in the detection and characterization of FLLs, the choice of therapeutic procedures, and the evaluation of response. Currently, CEUS is included as a part of the suggested diagnostic work-up of FLLs, including in cirrhotic patients with hepatocellular carcinoma, resulting in better patient management and cost-effective delivery of therapy.

Value of quantitative contrast-enhanced ultrasound based on S-G filter theory in the diagnosis of chronic rejection of transplant kidney / 中华器官移植杂志

Objective To explore the characteristics and differences of micro-perfusion between patients after transplant kidney with stable renal function,acute rejection and chronic rejection by contrast enhanced ultrasound (CEUS) quantifying.Methods Thirty-three patients with stable renal function,27 patients with acute rejection and 14 patients with chronic rejection were enrolled.The perfusion parameters of region of interest in renal cortex and medulla were obtained by CEUS offline data quantitative analysis software.The perfusion parameters in stable renal function group were compared with those in acute rejection and chronic rejection groups;furthermore,the value of color Doppler and CEUS in the diagnosis of chronic rejection was explored and compared.Results As for resistance index RI on color Doppler,it made no statistical difference among three groups (P＞0.05).The perfusion parameters derived from CEUS quantitative analysis and Color Doppler parameter resistance index (RI) were not statistically different among renal function stabilization,acute rejection and chronic rejection groups (P＞0.05);as compared with stable renal function group,there were marked reductions in peak intensity of cortex (PIc),peak intensity of medulla (PIm),ascending slope of cortex (a3c),ascending slope of medulla (a3m) and area under the curve of cortex (AUCc) in chronic rejection group.And mean transit time of cortex (MTTc) and mean transit time of medulla (MTTm) became significantly prolonged (P＜ 0.05).Except for a3m,PIc and PIm were not significantly different between stable renal function and acute rejection groups (P＜ 0.05).As compared with acute rejection group,MTTc and MTTm were significantly prolonged in chronic rejection group while AUCm and PIm declined markedly (P＜0.05).When PIm＜26.7dB,the diagnostic efficiency of chronic rejection was the highest and the sensitivity and specificity were 85.7％ and 72.7％ respectively.Conclusions As compared with color Doppler,CEUS quantitative parameters based on S-G filter theory can evaluate the micro-perfusion of transplant kidney more precisely and may provide diagnostic clue for chronic rejection.

Research progress in ultrasound use for the diagnosis and treatment of cerebrovascular diseases

Cerebrovascular diseases pose a serious threat to human survival and quality of life and represent a major cause of human death and disability. Recently, the incidence of cerebrovascular diseases has increased yearly. Rapid and accurate diagnosis and evaluation of cerebrovascular diseases are of great importance to reduce the incidence, morbidity and mortality of cerebrovascular diseases. With the rapid development of medical ultrasound, the clinical relationship between ultrasound imaging technology and the diagnosis and treatment of cerebrovascular diseases has become increasingly close. Ultrasound techniques such as transcranial acoustic angiography, doppler energy imaging, three-dimensional craniocerebral imaging and ultrasound thrombolysis are novel and valuable techniques in the study of cerebrovascular diseases. In this review, we introduce some of the new ultrasound techniques from both published studies and ongoing trials that have been confirmed to be convenient and effective methods. However, additional evidence from future studies will be required before some of these techniques can be widely applied or recommended as alternatives.

Diagnostic value on the analysis of contrast-enhanced ultrasound and quantitative mode of benign and malignant thyroid nodule and the diagnostic value of quantitative model on it / 中国医学装备

Objective: To study ultrasound contrast enhanced mode of benign and malignant thyroid nodule and the change of related quantitative parameter of time intensity curve(TIC).Methods: Retrospective analysis was applied to analyze the mode that contrast agent went into nodules when 125 thyroid nodules of 112 patients with thyroid nodule received ultrasound contrast,and to analyze enhanced mode and distribution situation of contrast agent.The change of TIC was observed and analyzed.And when contrast agent went into nodule,the quantitative parameters included arrive time(AT),peak intensity(PI),time to peak(TTP)and K value of rate of curve were recorded.Results: 58 nodules were benign and 67 nodules were malignant in the 125 thyroid nodules.The rim of benign nodules appeared circular enhancement(82.7％)after contrast agent went into benign nodule.And the malignant nodules appeared non-circular enhancement(77.6％),and the difference of them was no significant(x2=28.32,P＜0.05).Most of malignant nodules appeared asymmetrical enhancement after contrast agent was infused in them(91.0％),and the difference of ultrasound contrast between benign nodules and malignant nodules was significant(x2=17.56,P＜0.05).When the contrast agent of malignant nodules achieved peak value,its main appearance was low enhancement(83.6％),and the contrast agent of benign nodules achieved peak value,the main appearance was equivalent enhancement(86.2％),and the difference of appearance between malignant nodule and benign nodule was significant(x2=41.65,P＜0.05).The differences of parameters of TIC included AT,PI,TTP and K value between malignant nodules and benign nodules were significant(t=2.964,t=3.021,t=-2.914,t=2.652,P＜0.05).Conclusion: For diagnosis of thyroid nodule that mainly contained solid nodule and cystic solid nodule,ultrasound contrast enhancement and TIC included variously quantitative parameters have higher clinical application value.

The clinical application of microbubble contrast agent in high intensity focused ultrasound treatment for uterine fibroids / 介入放射学杂志

Objective To investigate the clinical utility of SonoVue,a microbubble-enhancing contrast agent,in the treatment of uterine fibroids carrying different signal intensities on T2WI with high-intensity focused ultrasound (HIFU).Methods Based on the preoperative MRI signal intensity on T2WI,a total of 64 patients with uterine fibroids,who were scheduled to receive HIFU,were divided into low-intensity group (n =24),iso-intensity group (n =22) and high-intensity group (n =18).MRI check-up examination was performed one day after HIFU treatment to evaluate the ablation effect.The parameters related to HIFU,including therapeutic power,irradiation time and therapeutic dose,and the indexes related to therapeutic effect,including volume ablation rate (non-perfusion volume ratio,NPVR),energy-efficiency factor,treatment time,were recorded,and the results were compared between each other among the three groups.Results In the low-intensity group,iso-intensity group and high-intensity group,the volume ablation rates were (84.83±18.49)％,(8.72±17.76)％ and (71.11±23.87)％ respectively,the energy-efficiency factors were (6.87±7.77) J/mm3 (7.99±6.58) J/mm3 and (12.93±9.38) J/mm3 respectively,the treatment time were (102.12±54.45) min,(153.86±66.04) min and (141.50±69.56) min respectively.Single factor analysis indicated that statistically significant differences in volume ablation rate,energy-efficiency factor and treatment time existed between each other among the three groups.Among the total 64 patients,3 patients developed lower abdominal pain (6/64,9.4％),3 patients complained of general aches with numb (3/64,4.7％),and no severe complications,such as skin burn in treatment area,etc.,occurred in all patients.Conclusion The curative effect of SonoVue combined with HIFU for low-intensity and iso-intensity uterine fibroids is better than that for high-intensity uterine fibroids;the treatment time for low-intensity uterine fibroids is shorter than that for iso-intensity and high-intensity uterine fibroids.SonoVue is a safe and effective synergist for HIFU treatment.

Application value of ultrasound contrast on evaluating fallopian tube patency / 中国基层医药

Objective To discuss the clinical application value of ultrasound contrast on evaluating fallopian tube patency.Methods Ultrasound contrast examination was conducted on 84 patients suffering from infertility and the flowing status of contrast agent in the uterine cavity and the fallopian tube and the distribution condition in the pelvic cavity were observed under the real -time ultrasound to judge the patency condition of the fallopian tube.Results After 84 patients receiving ultrasound contrast,38 cases'bilateral fallopian tubes were unobstructed,26 cases'lateral fallopian tube were unobstructed and 20 cases'bilateral fallopian were obstructed.Comparing the result of ultrasound contrast with laparoscopy,the diagnosis accuracy was 89.5%,the specificity 86% and the sensitivity 94%.Conclusion Fallopian tube ultrasound contrast technique can make an accurate and objective evaluation on the fallopian tube patency,it is an effective method to check fallopian tube patency and it is of high clinical application value.

The value of intra-cavitary contrast enhanced ultrasound in percutanous nephrolithotomy for nephrolithiasis patients with slight or no hydronephrosis / 中华泌尿外科杂志

Objective To evaluate the feasibility and efficacy of intra-cavity contrast enhanced ultrasound (ICCE-US) in percutanous nephrolithotomy for nephrolithiasis patients with slight or no hydronephrosis.Methods From March 2016 to March 2017,ICCE-US-guided PCNL was performed in 35,patients who had kidney stones with slight hydronephrosis in 11 and without hydronephrosis in 24.The sample comprised 20 males and 15 females,including 10 with renal pelvic calculi alone,17 with renal pelvic calculi combined with renal calyx calculi,and 8 with partial staghorn calculi.Mean age was 46.8 years (ranging,28-75 years).The size of calculi ranged from 2.5 cm to 5.0 cm [mean(3.6 ± 1.2) cm].In the prone position,the preferred calyces are the posterior ones,which were enhanced by sulfur hexafluoride microbubbles (SonoVue) retrogradely injected through ureteral catheter.An 18-gauge needle was inserted toward the desirable calyx.Successful renal entry was confirmed by administration of ultrasound contrast agents into the collecting system via the needle regardless of whether spontaneous urine drainage was observed.A guidewire was passed through the needle to renal collecting system.Subsequently,the needle was removed.And the renal tract was dilated to F18-F20 size with dilators.Finally,holmium laser lithotripsy was performed through nephroscopy.Results Posterior calyces and its fornix were revealed under contrast-enhanced ultrasound in all patients.The successive access rate was 100％.The average time for establishing the access was (8 ±2.6)min (ranging 5-10 min).The mean number of needle passes was (1.5 ± 0.3) times per kidney,ranged from 1 to 3 times.Hemoglobin level averagely reduced (11.3 ± 3.7) g/ L (ranging 6-15 g/L) within 24 hours postoperatively.No major complications,such as adjacent organs injuries or collecting system perforation were observed.No blood transfusion was needed.The mean hospital stay was (5.6 ± 1.2) days (ranging 5-7 days).The stone-free rate was 91.4％ (32/35).Conclusions ICCE-US can demonstrate clearly about the posterior calyces and its fornix as well as puncture needle site by contrast enhancement in the nephrolithiasis patients with slight or no hydronephrosis.It has the potential to improve the accuracy and successive rate of puncture resulting in a decrease in the puncture-related complications.

Values of high-frequency ultrasound, elastography and ultrasound contrast in diagnosis of thyroid solid nodules / 医疗卫生装备

Objective To investigate the diagnostic criteria of thyroid solid nodules by high-frequency ultrasound,elastography and ultrasound contrast.Methods Totally 87 patients with thyroid solid nodules underwent high-frequency ultrasound,elastography and ultrasound contrast before surgery,distinguishing benign from malignant lesions was executed based on pathological results,and according to the pathological character the image features by the three measures were compared.There were 40 patients divided into a control group going through the examination by high-frequency ultrasound,and 47 ones into an observation group with the examinations by the three measures.Pathological results were used as gold standard,and the two groups were compared on diagnostic sensitivity.Results High-frequency ultrasound showed significant differences of benign and malignant nodules in equal echo,very low echo,irregular peripheral halo,rates of clear nodule boundary and aspect ratio higher than as well as microcalcification (x2--4.603,17.394,5.833,14.832,10.107 and 27.392,and all Pvalues were less than 0.05).There were 85％ benign nodules gained grade Ⅰ and Ⅱ elastography images,81.82％malignant nodules had grade Ⅲ and ⅣV elastography images,and there were significant differences between benign and malignant nodules (x2=53.42,P=0.00).Ultrasound contrast found annular enhancement in most of benign nodules (x2=39.16,P＜0.01) while uneven enhancement in most of malignant nodules (x2=40.28,P＜0.01),and the nodule ranges increasedsignificantly after contrast (t=2.19,P＜0.05).The observation group had the sensitivity being 82.86％,which was statisticallyhigher than 59.38％ in the control group (x2=4.537,P--0.033).Conclusion High-frequency ultrasound,elastography and ultrasound contrast all show the manifestations of thyroid solid nodules,and the comprehensive application of the above three measures contributes to determining the nature of the nodules.

The value of intra-cavitary contrast enhanced ultrasound in percutanous nephrolithotomy for nephrolithiasis patients with slight or no hydronephrosis / 中华泌尿外科杂志

Objective To evaluate the feasibility and efficacy of intra-cavity contrast enhanced ultrasound (ICCE-US) in percutanous nephrolithotomy for nephrolithiasis patients with slight or no hydronephrosis.Methods From March 2016 to March 2017,ICCE-US-guided PCNL was performed in 35,patients who had kidney stones with slight hydronephrosis in 11 and without hydronephrosis in 24.The sample comprised 20 males and 15 females,including 10 with renal pelvic calculi alone,17 with renal pelvic calculi combined with renal calyx calculi,and 8 with partial staghorn calculi.Mean age was 46.8 years (ranging,28-75 years).The size of calculi ranged from 2.5 cm to 5.0 cm [mean(3.6 ± 1.2) cm].In the prone position,the preferred calyces are the posterior ones,which were enhanced by sulfur hexafluoride microbubbles (SonoVue) retrogradely injected through ureteral catheter.An 18-gauge needle was inserted toward the desirable calyx.Successful renal entry was confirmed by administration of ultrasound contrast agents into the collecting system via the needle regardless of whether spontaneous urine drainage was observed.A guidewire was passed through the needle to renal collecting system.Subsequently,the needle was removed.And the renal tract was dilated to F18-F20 size with dilators.Finally,holmium laser lithotripsy was performed through nephroscopy.Results Posterior calyces and its fornix were revealed under contrast-enhanced ultrasound in all patients.The successive access rate was 100％.The average time for establishing the access was (8 ±2.6)min (ranging 5-10 min).The mean number of needle passes was (1.5 ± 0.3) times per kidney,ranged from 1 to 3 times.Hemoglobin level averagely reduced (11.3 ± 3.7) g/ L (ranging 6-15 g/L) within 24 hours postoperatively.No major complications,such as adjacent organs injuries or collecting system perforation were observed.No blood transfusion was needed.The mean hospital stay was (5.6 ± 1.2) days (ranging 5-7 days).The stone-free rate was 91.4％ (32/35).Conclusions ICCE-US can demonstrate clearly about the posterior calyces and its fornix as well as puncture needle site by contrast enhancement in the nephrolithiasis patients with slight or no hydronephrosis.It has the potential to improve the accuracy and successive rate of puncture resulting in a decrease in the puncture-related complications.