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Objective To evaluate the value of real-time ultrasonic elastography in the differential diagnosis of rectal tumors.Methods One hundred patients (30 cases of adenoma and 70 cases of adenocarcinoma) with rectal tumors proved by pathology and 70 normal subjects referred to the First Affiliated Hospital of China Medical University from April 2012 to October 2013 were included in this prospective cohort. All patients underwent real-time ultrasonic elastography. The tumour tissue and reference tissue were chosen for strain ratio measurements. Only tumor tissue was selected for the tumor sample area. Tissue recognized as normal rectal wall and perirectal tissue was selected as the reference sample area. At the same time the elasticity score were calculated. Receiver operating characteristic (ROC) curves of the elasticity score and strain ratio method were used to find the cut-off point of adenoma and adenocarcinoma. The corresponding sensitivity, accuracy and specifi city were calculated. One-way ANOVA was used to comparestrain ratio value among healthy control group, retal adenoma group and rectal adenocarcinoma group and among patients with different preoperative stages of adenocarcinoma group. LSD-t test was used to compare strain ratio value between two groups.Results ROC curve showed that the best cut-off value of elasticity score in diagnosis of rectal tumor was 3, the sensitivity, specificity and accuracy were 85.1%, 73.1% and 82.0%, and the area under ROC curve was 0.780. The best cut-off value of strain ratio in diagnosis of rectal tumour was 2.34, the sensitivity, specifi city and accuracy in diagnosis were 91.4%, 83.3% and 89.0%, and the area under ROC curve was 0.945. Strain ratio of healthy control group, rectal adenoma group and rectal adenocarcinoma group was 0.74±0.44, 1.75±0.58 and 7.48±6.80. There was signifi cantly statistical difference among three groups in strain ratio. Compared with the strain ratio of healthy control group and rectal adenoma group, that of rectal adenocarcinoma group was higher (t=-8.26, P=0.000; t=-6.98,P=0.000). Compared with the strain ratio of healthy control group, that of rectal adenoma group was higher (t=-8.53,P=0.000). Strain ratio of patients with preoperative pathological stages T1, T2, T3 and T4 rectal carcinoma was 4.91±3.60, 7.07±7.23, 8.64±2.62 and 8.58±9.95 and there was no significantly statistical difference among patients with different preoperative stages of adenocarcinoma group (F=0.86,P=0.47).Conclusion The real-time ultrasonic elastography is a promising modalityfor the differential diagnosis of rectal tumors.
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Objective To investigate the value of plasma N terminal brain natriuretic peptide (NT-BNP) in dialysis adequacy assessment of maintenance hemodialysis (MHD).Methods One hundred and twelve MHD patients were divided into hemodialysis adequacy group (group A,63 patients,cardiothoracic ration ＜0.5) and hemodialysis inadequate group (group B,49 patients,cardiothoracic ration ≥ 0.5).The plasma NT-BNP levels of pre-dialysis,dialysis end,4th and 24th hour after dialysis were compared.Before and after dialysis the inferior vena cava diameter (VCD) was checked.The correlation between NT-BNP level at the end of dialysis,cardiothoracic ration and post dialysis VCD were analyzed.Results The levels of NT-BNP in group A,B before dialysis were(13 808 ± 7611) and (25 573 ± 8444)ng/L respectively,and there was significant difference (P ＜ 0.01).The levels of NT-BNP in two groups increased at the end of dialysis,but there was no significant difference (P ＞0.05).Then the levels of NT-BNP in two groups decreased significantly at 4th hour after dialysis (P ＜ 0.01).The levels of NT-BNP in two groups at 4th hour after dialysis were (8256 ±6611) and (21 320 ±6828) ng/L,and there was significant difference (P＜ 0.01).At 24th hour after dialysis,the level of NT-BNP in group A was still at a low level,but in group B,the level of NT-BNP increased again.Before dialysis,the levels of VCD between two groups had no significant difference (P ＞ 0.05).After dialysis,the level of VCD in group B decreased significantly(P ＜ 0.05).After dialysis,the level of VCD in group B was significantly higher than that in group A(P＜ 0.05).The level of NT-BNP had positive relationship with cardiothoracic ration and VCD (r =0.462,P＜ 0.01 ;r =0.513,P＜ 0.01).Conclusion The level of NT-BNP can reflect the volume overload and urea clearance index of MHD,which may be a more comprehensive evaluation index of the adequacy of dialysis.
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Objective To study the sonograms of tuberculous peritonitis and improve the diagnostic accuracy of this disease.Methods We retrispectively analyzed 138 cases of tuberculous peritonitis diagnosed by ultrasonically guided biopsy,postoperative pathology,and clinical manifestation.The characteristics of the sonograms were analyzed,including the amount and character of ascites,the changes in greater omentum,peritoneum,and mesenterium.the enlarged celiac lymph nodes,and the organ involvement.Results The sonograms of tuberculous peritonitis were characterized by thickening of greater omentum with different degrees of ascites,which usually presented cerebral fissure sign under high-frequency ultrasound,together with aggregation of intestines,thickening of peritoneum,enlarged celiac lymph nodes,hepatomegaly,splenomegaly,and pleural effusion.Conclusion Ultrasonography is of great clinical significance in the diagnosis of tuberculous peritonitis and the guidance of greater omentum biopsy.