Effect of hepatogenous jaundice on liver stiffness measurement in patients with chronic hepatitis B / 中华超声影像学杂志

To evaluate the impact of intrahepatic cholestasis on liver stiffness measurement ( LSM ) of two‐dimensional shear wave elastography ( 2D‐SWE ) in patients with chronic hepatitis B . Methods Between June 2011 and December 2016 , total of 1 188 patients with chronic hepatitis B infection were enrolled to collect clinical ,2D‐SWE ,biochemical variables and histological ( M ET AVIR scoring system ) datas . LSM was compared between normal total bilirubin group ( TB ＜ 23 .9 μmol/L ) versus abnormal TB group( ≥23 .9 μmol/L ) . Correlation of TB with LSM s was assessed . Results Nine hundred and seventy‐three patients with effective LSM in the study were analyzed . Within the same fibrosis stage ( F1‐F4) ,LSM showed significantly higher value in abnormal TB group than those of normal TB group ( r＝0 .328 ,0 .247 ,0 .495 ,0 .435 ,all P ＜ 0 .001 ) . Increased LSM for abnormal TB group was generally found within different subset of patients [ fibrosis stage ≤ F2 ,AL T ≥ 2 × upper limit of normal ( ULN ) ;fibrosis stage≤ F2 ,M ET AVIR activity grade ≤ A1 or ≥ A2 ] ,with r ＝ 0 .266 ,0 .210 ,0 .243 ( all P ＜0 .001) ,respectively .Increased LSM for abnormal TB group was also found within different subset of patients [ fibrosis stage≥F3 ,AL T＜2× ULN ,≥2×ULN ; fibrosis stage≥F3 ,M ET AVIR activity grade≥A2 ,with r ＝ 0 .671 ,0 .200 ,0 .468 ( all P ＜ 0 .05 ) ] . Conclusions Hepatogenous jaundice induced to intrahepatic cholestasis shows slight positive correlation with LSM s in patients with chronic hepatitis B .

Two-dimensional Shear Wave Elastography in Predicting Prognosis of Patients with Acute-on-chronic Liver Failure / 中山大学学报(医学科学版)

[Objective]To evaluate the two-dimensional shear wave elastography(2D SWE)in predicting the prognosis of the patients with acute-on-chronic hepatitis B liver failure(ACLF-HBV).[Methods]312 patients diagnosed with ACLF-HBV at the De-partment of Infectious Diseases in the Third Affiliated Hospital of Sun Yat-sen University from October 1st 2013 to December 31th 2015 were recruited. The baseline data of all patients,including 2D SWE,laboratory data,ultrasonographic data,Model for End-stage Liver Disease score(MELD),Child-Turcotte-Pugh score(CTP),and King′s College Hospital score(KCH),were collected when enrolled. All patients were followed up for at least 90 days and their clinical outcomes(recovering or worsening)were recorded. 2D SWE values of all patients were dynamically collected every 2~4 weeks during the follow-up until death,liver transplantation, or discharging from hospital.[Results]The worsening patients showed higher 2D SWE values than the recovering ones[(44.0 ± 7.5) kPa vs(36.8 ± 10.3)kPa,t=-6.5,P=0.000],2D SWE value less than 39.2 kPa could be a prediction of the patient′s recovery in 90 days.The predictive value of 2D SWE(AUROC=0.73)was higher than that of KCH(AUROC:0.65,z=2.1,P=0.033). Among all the dynamically measured patients,2D SWE rose from(42.1 ± 8.0)kPa to(47.5 ± 9.3)kPa in the worsening group during the 90-day follow-up,while nearly stable in the recovery group.[Conclusion]Noninvasive liver stiffness measurement by 2D SWE is a use-ful method in evaluating the prognosis of ACLF-HBV patients. Taking a cutoff of 39.2 kPa,patients with higher 2D SWE values could have worse clinical outcomes ,otherwise better. It seems that dynamically measuring 2D SWE values could also be helpful ,but more research in the future should be needed.

Comparison of acoustic structure quantification and shear wave elastography in the assessment of diagnostic accuracy of liver fibrosis / 中华超声影像学杂志

Objective To compare the value of acoustic structure quantification(ASQ) and shear wave elastography(SWE) in the evaluation of diagnostic accuracy of liver fibrosis.Methods One hundred and thirty-five patients with chronic hepatic diseases enrolled in our study were underwent ASQ,SWE and liver biopsy.Correlation between Total Mode,BR ratio,the elastic modulus and pathological stages of liver fibrosis were analyzed by Spearman's rank test.ROC curves were set up by evaluating the degree of hepatic fibrosis through Total Mode,BR ratio,the elastic modulus.Results The significant positive correlation were observed between Total Mode,BR ratio,the elastic modulus and pathological stages of liver fibrosis(r =0.46,P =0.000; r =0.49,P =0.000; r =0.68,P =0.000,respectively).Total Mode,BR ratio,and the elastic modulus,of each pathological stages,had statistically significant differences (F =6.05,P =0.000 ; F =5.17,P =0.000; F =48.82,P =0.000,respectively).The areas under the ROC curve (AUC) set up by evaluating the pathological stages of fibrosis (S≥ 1,S≥2,S≥3 and S =4) through the elastic modulus were larger than that of Total Mode and BR ratio(all P ＜0.05).But the AUC for the diagnosis of fibrosis of Total Mode and BR ratio showed no statistically significant differences(all P ＞0.05).Conclusions SWE was more accurate than ASQ parameters (Total Mode,BR ratio) in grading hepatic fibrosis.ASQ parameters (Total Mode,BR ratio) were observed well-correlated with the pathological staging of hepatic fibrosis.

The relationship between serum pregnancy associated plasma protein A level and pregnancy outcomes in early pregnancy / 中国医师进修杂志

Objective To explore the relationship between pregnancy associated plasma protein A (PAPP-A) and threatened abortion,whether low level of PAPP-A in early pregnancy can be used as indicators to predict the pregnancy outcomes.Methods The level of serum PAPP-A was measured by double antibody sandwich enzyme-linked immunosorbent assay in 110 cases with threatened abortion (threatened abortion group) and 131 cases with normal intrauterine pregnancy (control group),and track to 20 weeks pregnant.Results The serum PAPP-A multiple of median (MOM) value was 1.02 ± 0.15 in control group,0.98 ± 0.17 in threatened abortion group,and there was no significant difference(P ＞ 0.05).In threatened abortion group,90 cases of spuc success,the serum PAPP-A MOM value was 1.03 ± 0.11,20 patients of spuc failure,the serum PAPP-A MOM value was 0.73±0.21,and there was significant difference (P ＜ 0.01).There was no significant difference in the serum PAPP-A MOM value between control group and the spuc success of threatened abortion group (P ＞ 0.05).Conclusion Pregnant women with PAPP-A levels embryonic development is closely related to the good,as one can predict miscarriage in pregnant women with threatened abortion outcome evaluation.

Application of intra-cavitary contrast enhanced ultrasound in the location of drainage tubes / 中华超声影像学杂志

Objective To investigate the value of intra-cavitary contrast enhanced ultrasound(CEUS)in the location of drainage tubes which were unclear in conventional ultrasonography. Methods The locations of 32 drainage tubes in 26 patients were unclear in conventional ultrasonography. The diluted ultrasound contrast agent (SonoVue) was injected through the tubes. CEUS was used to evaluate the visualizations of the inner tubular portions and the distal ends. Whether the drainage tubes were in situ or not was also judged. The time-consumption of detection was counted. Results The percentages of the visualization of inner tubular portions and the distal ends in conventional ultrasonography were 52.25%(18/32) and 0,respectively. However,the percentages of visualization in CEUS were 100% and 93.75%(30/32), respectively. The difference were significant when compared conventional ultrasonography with CEUS ( P＜0.001 ). CEUS detected that three drainage tubes weren't in situ. And the median of timeconsumption of CEUS was just 4. 5 seconds (range: 1-77 seconds). Conclusions Intra-cavitary CEUS is a sensitive and high efficient technique in the visualization of drainage tube which may complement the insufficiency of conventional ultrasonography. It could be used as the first choice in the location of drainage tube.

Pancreatic and renal involvement in von Hippel-Lindau disease: imaging findings / 中华放射学杂志

Objective To analyze the imaging features and to enhance the understanding of pancreatic and renal involvement in yon Hippel-Lindau disease (VHLD). Methods CT and MRI appearances and clinical data of six patients with pancreatic and renal involvement in VHLD were studied retrospectively.Six patients underwent CT scanning, and two of them also had MRI.Results Pancreatic cysts found in all six patients varied from several small cysts to cystic replacement of the entire gland.Calcifications were detected in four patients. Multiple bilateral renal lesions were detected in six patients.The renal lesions were classified as cystic, cystic with solid components and solid.Multiple combined renal lesions were found in five patients, and multiple simple cysts in one patient.Unilateral nephrectomy was performed in two patients, and the renal masses were diagnosed as clear cell carcinoma by pathology.Bile carcinoid was found in one patient, and retroperitoneal metastasis in another.Conclusion Multiple pancreatic cysts and/or multiple and bilateral combined renal lesions are highly suggestive of VHLD.