Automated Breast Ultrasound: Interobserver Agreement,Diagnostic Value, and Associated Clinical Factors ofCoronal-Plane Image Features

Objective@#To evaluate the interobserver agreement, diagnostic value, and associated clinical factors of automated breastultrasound (ABUS) coronal features in differentiating breast lesions. @*Materials and Methods@#This study enrolled 457 pathologically confirmed lesions in 387 female (age, 46.4 ± 10.3 years),including 377 masses and 80 non-mass lesions (NMLs). The unique coronal features, including retraction phenomenon,hyper- or hypoechoic rim (continuous or discontinuous), skipping sign, and white wall sign, were defined and recorded. Theinterobserver agreement on image type and coronal features was evaluated. Furthermore, clinical factors, including the lesionsize, distance to the nipple or skin, palpability, and the histological grade were analyzed. @*Results@#Among the 457 lesions, 296 were malignant and 161 were benign. The overall interobserver agreement for imagetype and all coronal features was moderate to good. For masses, the retraction phenomenon was significantly associated withmalignancies (p < 0.001) and more frequently presented in small and superficial invasive carcinomas with a low histologicalgrade (p = 0.027, 0.002, and < 0.001, respectively). Furthermore, continuous hyper- or hypoechoic rims were predictive ofbenign masses (p < 0.001), whereas discontinuous rims were predictive of malignancies (p < 0.001). A hyperechoic rim wasmore commonly detected in masses more distant from the nipple (p = 0.027), and a hypoechoic rim was more frequently foundin large superficial masses (p < 0.001 for both). For NMLs, the skipping sign was a predictor of malignancies (p = 0.040). @*Conclusion@#The coronal plane of ABUS may provide useful diagnostic value for breast lesions.

Correlation analysis between psychological counseling behaviors of accompanying family members and anxiety and depression of inpatients with hepatocellular carcinoma / 中国实用护理杂志

Objective To understand the correlation between psychological counseling behaviors of accompanying family members and anxiety and depression of inpatients with hepatocellular carcinoma. Methods Used self-designed questionnaires to investigate the behaviors of 45 accompanying family members psychological counseling for their relative hospitalized patients with hepatocellular carcinoma, at the same time, evaluated the anxiety and depression among those 45 hospitalized patients with hepatocellular carcinoma, then analyzed the correlation between the accompanying family members' psychological counseling behaviors and hepatocellular carcinoma in patients' anxiety and depression. Results Among the accompanying family members,53.3%(24/45) were the spouses of the patients. During the accompanying nursing time, there were 20.0%(9/45) accompanying families told to their relative patients less than 2 hours per day, and 80.0%(36/45) told to the patients over 2 hours per day. The proportion of anxiety and depression in the hospitalized patients with hepatocellular carcinoma was 28.9%(13/45) and 77.8% (34/45) respectively. Whether the relationship between the accompanying family members and the patients with hepatocellular carcinoma were spouse relationship was related to the incidence of depression in the patients (χ2=10.470, P=0.005), and whether the time accompanying family members spent in talking with the patients over 2 hours every day was correlative with the incidence of anxiety and depression in the patients (χ2=7.012, P =0.030 andχ2=6.438, P=0.040). The patients who accompanying families told to them less than 2 hours per day suffered a higher depression rate (8/9), and among the patients who accompanying families told to them over 2 hours per day, the lowest rate of anxiety (1/12) was found in the patients who accompanying families told to them around 4.1-6.0 hours per day. Conclusions The patients who are accompanied and cared by their spouses have lower depression rate and lesser depression extent. The accompanying families talk to the patients total 4.1-6.0 hours per day could most favorably reduce the incidence of anxiety and depression in the hospitalized patients with hepatocellular carcinoma.

Feasibility research of preoperative evaluation of neoplastic microvascular morphology in hepatocellular carcinoma patients using contrast-enhanced ultrasound / 中华医学超声杂志（电子版）

Objective To explore the feasibility of contrast-enhanced ultrasonograhy (CEUS) in preoperative classification of hepatocellular carcinoma (HCC) microvascular morphology.Methods Totally 94 HCC patients who underwent CEUS were analyzed retrospectively. And the offline Time-intensity curve (TIC) were drawn using SonoTumor. The tumor size, alpha fetoprotein (AFP), cirrhosis, Child-Pugh classifi cation, tumor differentiation and TNM stage were statistically analyzed. The intratumoralmicrovessels of HCC in 94 cases were evaluated by CD34 immunohistochemical staining. The relationship between intratumoral microvessel morphology and CEUS parameters were analyzed.Results CD34 immunohistochemical staining showed three distinct microvessel types in 94 cases of HCC: 28 cases of capillary-like type, 14 cases of sinusoid-like type and 52 cases of mixed type. There were no significant differences of clinical data among three microvascular morphology types. The parameters of peak strength (PE), rise time (RT), wash-in rate (WiR), wash-in perfusion index (WiPI), wash-in area under the curve (WiAUC) and mean transit time (MTT) in 28 cases of capillary-like type were (4350.7±2566.0) a.u, (10.7±3.2) s, (717.0±489.9) a.u, (12820.3±8331.6 )a.u, (128 240.8±74 487.1) a.u, (71.9±33.1)s. Those parameters in 14 cases of sinusoid-like type were (2471.6±1107.1) a.u, (16.2±4.2)s, (321.9±171) a.u, (5 561.4±2 938.0) a.u, (86 780.1±47 563.7) a.u, (117.8±69.6)s. And in 52 cases of mixed type they were (3563.2±2343.1) a.u, (14.1±4.8)s, (519.4±403.2) a.u, (9 015.3±6 884.7)a.u, (128 240.8±74 487.1) a.u, (71.9±33.1) s respectively. The CEUS parameters of WiR, WiPI in capillary-like type HCC patients were higher than sinusoid-like type and mixed type HCC patients, while RT was lower than sinusoid-like type and mixed type HCC patients, and the differences were signifi cant (WiR: t=3.87, 3.3, bothP=0.05; WiPI: t=2.96, 2.06, bothP=0.05; RT: t=3.19, 2.34, bothP=0.05). The parameter of PE in capillary-like type HCC patients were signifi cantly higher than that in sinusoid-like type HCC patients (t=2.51,P=0.05). And the parameter of PE in capillary-like type HCC patients was higher than mixed HCC patients, but there was no signifi cant difference. The parameters of PE, WiR and WiPI in mixed type HCC patients were higher than that in sinusoid-like type HCC patients, while RT in mixed type HCC patients were lower than that in sinusoid-like type HCC patients, but there were no signifi cant differences. No signifi cant differences of WiAUC and MTT were observed in HCC patients with different microvascular morphology.Conclusions There were signifi cant differences of CEUS parameters in different microvascular morphology types. And CEUS, as a non-invasive method, can be used for preliminary preoperative prediction of microvascular morphology in HCC patients.

Clinical value of coronal plane reformatted with three-dimensional ultrasound in differential diagnosis of benign and malignant breast solid masses / 中华医学超声杂志（电子版）

Objective To evaluate the clinical value of the coronal plane of three-dimensional ultrasonography in the diagnosis of breast cancer. Methods Ninety-seven patients with 106 solid breast lesions were analyzed retrospectively. Two-dimensional images were evaluated with breast imaging reporting and data system for ultrasonography (BI-RADS-US) classification and were compared with pathological results. The value of two-dimensional ultrasound in the differentiation of benign and malignant lesions of breast lesions was evaluated. The ultrasonographic features on three-dimensional coronary plane of breast benign or malignant masses were analyzed by multiple stepwise binary logistic regression analysis. Receiver operating characteristic (ROC) curve was drawn and the areas under curves were calculated to evaluate the ability of regression model in diagnosis of benign and malignant breast lesions. Results The pathological results revealed that 106 lesions were consisted of 71 breast cancers and 35 benign neoplasms. The diagnostic accuracy, sensitivity and speciifcity were 85.8%, 84.5%and 88.6%respectively. Two ultrasonic features which were finally applied into the Logistic regression model were angulation or spiculation and′sun-like symptom′. The area under the ROC curve was 0.899, the standard error was 0.033, and the 95%conifdence interval was between 0.834 and 0.965. The logistic regression model could be useful for classiifcation of benign and malignant breast masses. The diagnostic accuracy was 88.7%(94/106), sensitivity was 90.1%(64/71), speciifcity was 85.7%(30/35), positive predictive value was 92.8%(64/69) and negative predictive value was 81.1%(30/37) respectively. Conclusions The coronal plane of breast three-dimensional, especially angulation or spiculation and′sun-like symptom′have an important value in the differential diagnosis of benign and malignant breast lesions. For complicated lesions, three-dimensional ultrasound coronal plane is helpful to improve the doctor′s diagnosis conifdence.

The sonographic feature of level Ⅱaxillary lymph node metastases from breast cancer / 中华医学超声杂志（电子版）

Objective To evaluate the feature of level Ⅱaxillary lymph nodes from breast cancer detected by ultrasound. Methods Eighty-nine cases of breast cancers with level Ⅱaxillary lymph nodes diagnosed in Sun Yat-sen University Cancer Center from January 2008 to October 2013 were retrospectively studied, including 66 cases of breast cancer patients pre-operatively, 23 cases of breast cancer post-operatively, all cases were female. The number, size, long/short ratio, presence of a hilum, and Doppler features of the lymph nodes were observed. The accuracy sensitivity, speciifcity, positive predictive value (PPV), and negative predictive value (NPV) of each signiifcant parameter were analyzed. Results Ultrasound examination revealed more than axillary lymph nodes, the accuracy sensitivity, specificity, positive predictive value and negative predictive value of diagnosing lymph nodes were 71.9%, 56.8%, 89.7%, 87.9%and 61.4%respectively. The maximum diameter of levelⅡaxillary lymph node was more than or equal to 10 mm, the accuracy sensitivity, specificity, positive predictive value and negative predictive value of diagnosing lymph nodes were 67.4%, 58.0%, 79.5%, 78.4%and 59.6%respectively. If there were two ultrasonographic characteristics simultaneously, the diagnostic sensitivity (87.8%) and accuracy (78.6%) could be significantly improved, the specificity, positive predictive value and negative predictive value of diagnosing lymph nodes were 60.0%, 72.3%and 80.0%. Conclusion The number and size of lymph nodes in level Ⅱaxillary area are valuable sonographic characteristics for the diagnosis of benign and malignant lymph nodes.

Is contrast enhanced ultrasonography helpful to assessment of myometrial invasion in endometrial carcinoma in stage Ⅰ / 中华超声影像学杂志

Objective To evaluate the accuracy of contrast enhanced ultrasonography (CEUS) in determining the depth of myometrial invasion in endometrial carcinoma in stage Ⅰ.Methods Seventy-six patients previously diagnosed of endometrial carcinoma by curettage of uterine underwent transabdominal sonography (TAS) and CEUS to assess myometrial invasion,among which 48 patients proved to endometrial carcinoma in stage Ⅰ after total abdominal hysterectomy and bilateral salpingo-oophorectomy were studied.The findings of TAS and CEUS to determine endometrial carcinoma IA (no myometrial involvement or invasion of the inner half of the myometrium) and IB( invasion of the outer half of the myometrium) were compared with pathology after abdominal hysterectomy.Results Twenty one tumours (43.75%,21/48) were enhanced earlier than or simultaneously as myometrium and cervix,among which 12 cases were IA stages,while 9 cases were IB stages (P0.05).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of TAS and CEUS in diagnosing endometrial carcinoma in IB were 61.25% vs 69.23%,77.14% vs 85.71%,50.00% vs 64.28%,72.92% vs 88.23%,72.92% vs 81.25% respectively.Conclusions CEUS is not superior to TAS in detecting deep invasion of endometrial carcinoma in stage Ⅰ.

Comparison of the imaging effects of SonoVue and Sonazoid at high frequency in rabbit-liver ultrasonography / 中华超声影像学杂志

Objective To compare the contrast enhancement effects of SonoVue and Sonazoid in rabbit liver at ultrasonic frequency of 7 MHz using various mechanical index(MI) and dosage. Methods Eight rabbits were bolus injected with different contrast agents:for SonoVue(0. 06 ml/kg,0. 12 ml/kg) ,MI ranging 0. 10 - 0. 55; while Sonazoid (0. 045 ml/kg, 0. 09 ml/kg) , MI ranging 0. 19 - 0. 98. Quantitative analysis of ultrasonography was done using video-intensity analysis system, and peak intensity (PI) was compared. Results With the same frequency, in SonoVue group, for both dosage groups, PI reached maximum at MI = 0. 15 ( P <0. 05) ; with the same MI, PI of the high dosage group was higher ( P < 0. 05). In Sonazoid group,for both dosage groups,PI reached maximum at MI = 0. 40( P <0. 05) ; with the same MI,PI of the high dose group was higher ( P <0. 05). Conclusions The optimistic ultrasonographic conditions provided to SonoVue and Sonazoid are different. Dosage of contrast agents, MI and frequency need to be concerned.

Contrast-enhanced ultrasonography of hepatocellular carcinoma: correlation between quantitative parameters and arteries in neoangiogenesis / 中华超声影像学杂志

Objective To explore the relationships between the quantitative parameters for contrastenhanced ultrasonography(CEUS) in hepatocellular carcinoma (HCC) and arteries in neoangiogenesis.Methods One hundred and fifteen HCCs in CEUS were analyzed off-line with dynamic vascular curve of ImageArena and immunohistochemical stained in the tissue slices.Parameters including maximum of intensity(IMAX),rise time(RT),time to peak(TTP),mean trasit time corresponding to the center of gravity(mTT) ,rise slope(RS) and washout time(WT) were analyzed by statistics.Unpaired arteries(UAs)of 82 HCC cases were succesfully stained.Results The number of UAs had moderate correlation with RT (r = - 0.446),TTP (r = - 0.432) and RS (r = 0.431) (P ＜ 0.05),and it had mild correlation with IMAX (r = 0.303) ,WT (r = 0.285) (P ＜0.05).Conclusions Neoangiogenesis is a functional adaptation to altered vascular dynamics.Quantitative parameters of CEUS,reflecting hemodynamics of tumors,are correlated with UAs.

Assessment of antiangiogenic therapeutics effect in a mouse hepatoma model using contrast-enhanced gray-scale ultrasound / 中华超声影像学杂志

Objective To evaluate antiangiogenic therapeutics effect with contrast-enhanced gray-scale ultrasound.Methods Kun-min mouse with subcutaneously implanted H22 mice hepatoma were treated with thalidomide or placebo by oral gavage over 7 days, starting at clay 2 post-implantation.Contrast-enhanced gray-scale ultrasound was performed on day 8.The tumor maximum cross-sectional area and non-enhanced area in ultrasound imaging were measured on the ultrasound machine.The percent of non-enhanced area from contrast-enhanced gray-scale ultrasound was calculated.Immediately after imaging, minces were euthanized and tumor tissue removed for fixation in a 10% formalin solution.The section equivalent to ultrasound imaging plane was stained with Hematoxylin and Eosin(HE) to allow for assessment of maximum cross-section area and necrotic area.The percent of necrotic area from HE stained section was calculated.Results The difference of maximum cross-sectional area measured in ultrasound and pathology slice was not significant between control and treated tumors (P >0.05).Ultrasound measurement of the tumor non-enhanced area and the percent of non-enhanced area were significantly larger in treated tumors than in control tumors (P <0.001).The necrotic area and the percent of necrotic area measured from HE stained section were also significantly larger in treated tumors than in control tumors (P < 0.001).The maximum cross-sectional area determined by the two methods was well corrected (r = 0.815, P < 0.001).There was good correlation between the non-enhanced area in contrast-enhanced gray-scale ultrasound and the necrotic area in pathology slides (r = 0.909, P <0.001).The percent of non - enhanced area calculated from ultrasound highly correlated with necrotic area estimated by pathology slides (r = 0.910, P <0.001).Conclusions Contrast-enhanced gray-scale ultrasound can detect the intratumoral necrosis and changes of tumor perfusion caused by antiangiogenic treatment before apparent change in tumor volume.

Effect of cirrhosic liver on dynamic vascular curves analysis of hepatocellular carcinomas at contrast-enhanced ultrasound / 中华超声影像学杂志

Objective To study the effect of cirrhosic liver on dynamic vascular curves analysis f(t)of hepatocellular carcinomas(HCCs) at contrast-enhanced ultrasound by exploring the difference between perfusion parameters of HCCs in cirrhotic liver and that in noncirrhotic liver. Methods One hundred and fifteen HCCs were analyzed off-line with dynamic vascular curve f(t) of Sonoliver. The HCCs were divided into 2 groups based on their background liver as cirrhotic liver group ( n = 86) and noncirrhotic liver group ( n =29). Such parameters as maximum of intensity(IMAX) ,rise time (RT,from 10% to 90% of IMAX),time to peak(TTP) ,mean trasit time(mTT) ,rise slope(RS) and washout time(WT) of the two groups were analyzed by statistics. Results There was no significant difference in the f(t) parameters of HCCs between cirrhotic liver group and noncirrhotic group(P >0. 05) [IMAX:(124. 25 ± 5. 56)% vs (113. 65 ± 5. 58)% ; RT: (12. 98 ± 0. 48)s vs (13. 68 ± 0. 92)s;TTP:(13. 70 ± 0. 52)s vs (14. 39 ± 0. 9)s;mTTi(138. 61 ± 9. 20)s vs (149. 49 ± 21. 70)s;RS:10. 11 ± 0. 60 vs 8. 89 ± 0. 77, WT: (34.17 ± 2. 91 )s vs (28. 36 ± 3. 25)s]. There was also no significant statistical difference in all above parameters in reference regions for the two group (P > 0. 05). Conclusions The f(t) parameters in HCCs can evaluate blood perfusion of the tumors, and cirrhotic liver does not affect the perfusion parameters of HCCs.

Value of quantitatively analyzing tissue perfusion parameters of contrast enhanced ultrasound in the evaluation of antiangiogenic therapeutics effect in a mouse hepatoma model / 中华超声影像学杂志

Objective To evaluate the value of quantitatively analyzing tissue perfusion parameters of contrast-enhanced ultrasound in the evaluation of antiangiogenic therapeutics effect. Methods Kun-min mouse were subcutaneously implanted with H22 cells. Ten mouse were treated with thalidomide (200 mg/kg once daily) by intraperitoneal injection over 7 days,starting at day 2 post-implantation. Ten control mouse were treated with an equivalent volume of 0.5 CMC. Contrast-enhanced gray-scale ultrasound was performed on day 8 after bolus injection of SonoVue (0.1 ml) and the imaging was recorded on cine.Regions of interest within tumour were analyzed off-line with the software of SonoLiver to determine the area under the curve (AUC), maximum intensity (Imax), perfusion index (PI), mean transit time (mTT),time to peak (TTP) and quality of fit (QOF). Immediately after imaging, minces were euthanized and tumour tissue removed for fixation in a 10% formalin solution. Microvascular density (MVD) was measured after anti-CD34 staining. Results The body weight and the tumor volume of treated tumors were significant different (lower) than that of control tumors (P ＜0.05). Treatment with thalidomide resulted into a significant decrease in AUC,PI and Imax in comparison with control tumors ( P ＜0.05). There were no significant difference in mTT and TTP between control and treated tumours ( P ＞0.05). Treated tumours were associated with a significantly lower MVD as compared with control tumours( P ＜0.05). ConclusionsQuantitatively analyzing tissue perfusion parameters of contrast enhanced ultrasound shows promise for monitoring tumor response to antiangiogenic therapy.

Analysis of Drug-induced Renal Injury in Inpatients in Our Hospital / 中国药房

OBJECTIVE:To investigate the drug-induced renal injury of inpatients in our hospital and provide information for rational use of drugs.METHODS:A retrospective analysis was performed in 102 cases whose blood Cr level was abnormal in June,August,and October in 2007.RESULTS:Of the 102 cases,20 patients(19.6%)suffered from drug-induced renal injury induced by 22 suspected drugs including dehydrants,antibiotics and ACEI et al.CONCLUSION:To avoid drug-induced renal function injury,medication should be carried out by strictly following indications and the dosage and administration stated in the drug package insert.