Two-Dimensional Shear Wave Elastography Predicts Liver Fibrosis in Jaundiced Infants with Suspected Biliary Atresia: A Prospective Study

Objective@#This study aimed to evaluate the role of preoperative two-dimensional (2D) shear wave elastography (SWE) in assessing the stages of liver fibrosis in patients with suspected biliary atresia (BA) and compared its diagnostic performance with those of serum fibrosis biomarkers. @*Materials and Methods@#This study was approved by the ethical committee, and written informed parental consent was obtained. Two hundred and sixteen patients were prospectively enrolled between January 2012 and October 2018. The 2D SWE measurements of 69 patients have been previously reported. 2D SWE measurements, serum fibrosis biomarkers, including fibrotic markers and biochemical test results, and liver histology parameters were obtained. 2D SWE values, serum biomarkers including, aspartate aminotransferase to platelet ratio index (APRi), and other serum fibrotic markers were correlated with the stages of liver fibrosis by METAVIR. Receiver operating characteristic (ROC) curves and area under the ROC (AUROC) curve analyses were used. @*Results@#The correlation coefficient of 2D SWE value in correlation with the stages of liver fibrosis was 0.789 (p < 0.001). The cut-off values of 2D SWE were calculated as 9.1 kPa for F1, 11.6 kPa for F2, 13.0 kPa for F3, and 15.7 kPa for F4. The AUROCs of 2D SWE in the determination of the stages of liver fibrosis ranged from 0.869 to 0.941. The sensitivity and negative predictive value of 2D SWE in the diagnosis of ≥ F3 was 93.4% and 96.0%, respectively. The diagnostic performance of 2D SWE was superior to that of APRi and other serum fibrotic markers in predicting severe fibrosis and cirrhosis (all p < 0.005) and other serum biomarkers. Multivariate analysis showed that the 2D SWE value was the only statistically significant parameter for predicting liver fibrosis. @*Conclusion@#2D SWE is a more effective non-invasive tool for predicting the stage of liver fibrosis in patients with suspected BA, compared with serum fibrosis biomarkers.

Two-Dimensional Shear Wave Elastography Predicts Liver Fibrosis in Jaundiced Infants with Suspected Biliary Atresia: A Prospective Study

Objective@#This study aimed to evaluate the role of preoperative two-dimensional (2D) shear wave elastography (SWE) in assessing the stages of liver fibrosis in patients with suspected biliary atresia (BA) and compared its diagnostic performance with those of serum fibrosis biomarkers. @*Materials and Methods@#This study was approved by the ethical committee, and written informed parental consent was obtained. Two hundred and sixteen patients were prospectively enrolled between January 2012 and October 2018. The 2D SWE measurements of 69 patients have been previously reported. 2D SWE measurements, serum fibrosis biomarkers, including fibrotic markers and biochemical test results, and liver histology parameters were obtained. 2D SWE values, serum biomarkers including, aspartate aminotransferase to platelet ratio index (APRi), and other serum fibrotic markers were correlated with the stages of liver fibrosis by METAVIR. Receiver operating characteristic (ROC) curves and area under the ROC (AUROC) curve analyses were used. @*Results@#The correlation coefficient of 2D SWE value in correlation with the stages of liver fibrosis was 0.789 (p < 0.001). The cut-off values of 2D SWE were calculated as 9.1 kPa for F1, 11.6 kPa for F2, 13.0 kPa for F3, and 15.7 kPa for F4. The AUROCs of 2D SWE in the determination of the stages of liver fibrosis ranged from 0.869 to 0.941. The sensitivity and negative predictive value of 2D SWE in the diagnosis of ≥ F3 was 93.4% and 96.0%, respectively. The diagnostic performance of 2D SWE was superior to that of APRi and other serum fibrotic markers in predicting severe fibrosis and cirrhosis (all p < 0.005) and other serum biomarkers. Multivariate analysis showed that the 2D SWE value was the only statistically significant parameter for predicting liver fibrosis. @*Conclusion@#2D SWE is a more effective non-invasive tool for predicting the stage of liver fibrosis in patients with suspected BA, compared with serum fibrosis biomarkers.

Ultrasound evaluation value of portal vein stenosis after pediatric liver transplantation / 器官移植

Objective To investigate the ultrasonographic features and its diagnostic value in portal vein stenosis (PVS) after pediatric liver transplantation. Methods Clinical data of 84 pediatric recipients undergoing liver transplantation who were followed up by routine ultrasound were retrospectively analyzed. According to ultrasound and digital subtraction angiography (DSA) results, all recipients were divided into the normal group (n=57) and PVS group (n=27). The incidence of PVS was assessed by ultrasound. The measurement parameters consisted of diameter of portal vein anastomosis, flow velocity of portal vein anastomosis, hepatic artery velocity, resistance index (RI) of hepatic artery and maximum diameter of the spleen, etc. The ultrasound parameters were statistically compared between the PVS and normal groups. The diagnostic value of ultrasound parameters for PVS after pediatric liver transplantation was evaluated. Results The diameter of portal vein anastomosis in the normal group was significantly larger than that in the PVS group[(0.44±0.08) cm vs. (0.27±0.10) cm], and the flow velocity of portal vein anastomosis in normal group was significantly lower than in the PVS group[(43±12) cm/s vs. (119±58) cm/s] (both P < 0.001). The hepatic artery velocity, RI of hepatic artery and maximum diameter of the spleen did not significantly differ between two groups (all P > 0.05). The diameter of portal vein anastomosis for the optimal diagnosis of PVS in pediatric liver transplantation, pediatric liver transplantation from organ donation after citizen's death and living-related donor pediatric liver transplantation was 0.35 cm, 0.35 cm and 0.33 cm, respectively. The corresponding area under curve (AUC) was 0.906, 0.916 and 0.906, the sensitivity was 0.947, 0.951 and 0.938, and the specificity was 0.852, 0.833 and 0.889, respectively. The flow velocity of portal vein anastomosis for the optimal diagnosis of PVS was 62.7 cm/s, 69.6 cm/s and 61.2 cm/s. The AUC was 0.990, 0.993 and 1.000, the sensitivity was 1.000, 1.000 and 1.000, and the specificity was 0.930, 0.951 and 1.000. Conclusions Ultrasound features of the pediatric recipients with PVS after liver transplantation include the smaller diameter of portal vein anastomosis and faster anastomotic flow velocity, which possess high diagnostic value.

Comparison analysis of ultrasonographic characteristics of hepatic neuroendocrine neoplasm with different primary sites and pathological grades / 中华超声影像学杂志

Objective To investigate the ultrasonography discrepancy of hepatic neuroendocrine neoplasm ( hNEN ) derived from different primary locations and pathological grades . Methods From August 2010 to April 2016 ,50 consecutive patients with 54 hNENs confirmed by pathology and imaging diagnosis underwent baseline ultrasound ( BUS ) and contrast-enhanced ultrasound ( CEUS ) in the First Affiliated Hospital of Sun Yat-sen University were enrolled in the retrospective study . On the basis of primary sites ,all hNENs were divided into three groups :pancreas ,gastrointestinal tract and other location groups . According to the pathological grading ,the hNENs were divided into hNET ( hepatic neuroendocrine tumor) group and hNEC ( hepatic neuroendocrine carcinoma) group . The imaging features of BUS and CEUS were retrospectively investigated and the ultrasonography discrepancy of hNEN derived from different primary focus and pathological grades were compared . Results ① Comparison of hNEN derived from different primary sites :hNEN derived from pancreas and gastrointestinal tract were smaller than hNEN derived from other sites[ ( 3 .8 ± 2 .6) cm vs ( 8 .7 ± 7 .0) cm , P = 0 .037 ;( 2 .9 ± 2 .1) cm vs ( 8 .7 ± 7 .0) cm , P = 0 .005] ,but the difference between the pancreas and gastrointestinal tract was not statistically significant ( P = 1 .0 ) . As for the pattern of CEUS enhancement ,hNEN derived from pancreas and gastrointestinal tract usually showed homogenous enhancement ( 13/19 ,15/23) while hNEN derived from other primary sites usually showed heterogeneous enhancement ( 10/13) ,and the difference was statistically significant ( P = 0 .025) . ② Comparison of hNET and hNEC :the distinction of enhancement level in the portal phase of contrast-enhanced ultrasound was statistically significant ( P = 0 .033) . All hNEC appeared hypo-enhancement ,while a small part of hNET ( 7/31 ) appeared iso-enhancement .More hNEC lesions showed heterogenous enhancemnt than hNET in the arterial phase ( 14/21 vs 9/31 , P = 0 .007) ,and there were less hNEC lesions presented tumor bleeding vessels than hNET ( 8/21 vs 22/31 , P = 0 .019 ) . Conclusions hNEN derived from pancreas and gastrointestinal tract are in a manner similar to hNEN derived from other primary sites on ultrasonography , so it' s difficult to identify in ultrasound . The ultrasonographic features of hNEC are more resemble to malignancy and it can be distinguished from hNET .

Application of contrast-enhanced ultrasonography in pediatric abdominal disease / 中华超声影像学杂志

Objective To investigate the security,applicability and diagnostic capacity of intravenous contrast-enhanced ultrasound (CEUS) in a pediatric population. Methods A total of 53 pediatric patients (8 months to 18 years old) received 66 intravenous applications of ultrasound contrast agent SonoVue.Side effects were documented.Histology,reference imaging or clinical diagnosis were compared with CEUS diagnostic results. Results Adverse effects occurred in 1/66 applications (1.5% ). For 44 focal liver lesions,the sensitivity was 100%,the specificity was 95.65%,the positive predictive value was 95.45% and the negative predictive value was 100%.The diagnostic accuracy was 97.73%.All 22 other lesions were diagnosed correctly.Conclusions It is safe and feasible to use intravenous CEUS in children.CEUS is worthy of promotion in pediatric patients with abdominal diseases.

Contrast-enhanced ultrasound in pediatric population / 中国医师杂志

This article mainly summarized the safety and effectiveness of SonoVue (LUMASON) in pediatric intravenous application for contrast-enhanced ultrasound examination.

Ultrasound-guided percutaneous ablation treatment for current hepatoblastoma: initial single-center experience / 中国医师杂志

Objective To summarize the first experience with ultrasound-guided percutaneous ab lation treatment (PAT) for recurrent hepatoblastoma (HB) after liver resection in children.Methods From August 2013 to April 2015,PAT was used to treat 6 children with a total of 9 recurrent HB,including 5 patients with 8 tumors in the liver and 1 patient with 1 tumor in the lung.The mean size of ablated tumors was (1.5 ± 0.8) cm,and the tumor size range was 0.7 cm to 3.1 cm.Results Four patients were performed percutaneous radiofrequency ablation (RFA) for recurrent HB;and 2 patients were performed percutaneous ethanol injection (PEI).Ablation success was achieved in all patients (6/6,100％).The complete ablation rate after the first ablation session was 88.9％ (8/9) on a tumor-by-tumor basis.Only 1 patient developed a fever with temperature ＞ 39 ℃;it was resolved by conservative therapy.During the follow-up period of 5-30 months,3 patients died to tumor progression.The 1-and 2-year overall survival rates after ablation were 83.3％ and 41.7％,respectively.Conclusions PAT is a safe and promising therapy for children with recurrent HB after liver resection,and further investigation in large-scale randomized clinical trials is required to determine its role in the treatment of this disease.

Study of the influent factors and reconstructing condition for the virtual endoscopy technique Fly-Thru (FT) in bile duct model in vitro / 中华超声影像学杂志

Objective To investigate the factors affecting Fly-Thru (FT) and the best reconstruction conditions in a bile duct model.Methods The bile duct model was made with corn powder and rubber pipes.FT data of bile duct in vitro were acquired with a 3-dimensional probe of Toshiba Aplio 500,and the data were reconstructed offline in Fly-Thru workstation.Two US doctors assessed the FT images in three degrees.Results The images were divided into good,moderate and poor groups with corresponding score 3,2,1.Of 162 images,72 were rated as grade 1,57 as grade 2 and 33 as grade 3.According to x2 analysis,the diameter,scanning way,and Filter were brought into multinomial regression,then the scanning way was found to be correlated to FT images quality as well as filter (likelihood ratio =87.598,294.290,x2 =9.492,313.722,respectively,P ＜0.01).Best images of FT can be acquired by transverse scanning,reconstructing in Filter =3,gain =5(0,dynamic range (DR) =50 and threshold ranging 40-90.Conclusions Best FT images in the model could be achieved by scanning in short-axis,and reconstructing the data in Filter =3,gain =50,DR =5(0 and threshold ranging 40-90,which would be basic information for advanced clinic study.

Voiding urosonography with SonoVue and fluoroscopic voiding cystourethrography in evaluation of vesicoureteral reflux: a comparative study / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the value of voiding urosonography (VUS) with SonoVue in evaluation of vesicoureteral reflux.</p><p><b>METHODS</b>Thirty-six pediatric patients (72 pyeloureter units [PUUs]) suspected of vesicoureteral reflux underwent both VUS and fluoroscopic voiding cystourethrography (VCUG). The sensitivity of VUS and VCUG and their consistency in detecting vesicoureteral reflux as well as in grading vesicoureteral reflux were compared.</p><p><b>RESULTS</b>Vesicoureteral reflux was detected in 26 of the 72 PUUs (36.1%) by VUS while in 21 PUUs (29.2%) by VCUG (P=0.347). The two modalities yielded the same results for 65 PUUs (κ=0.843), showing a very good consistency between them. VUS also detected post-urethral valve in 2 patients via transperineal scans.</p><p><b>CONCLUSION</b>VUS with Sonovue has at least comparable, if not better, sensitivity in detecting vesicoureteral reflux with VCUG, and therefore should serve as the primary screening and follow-up modality for vesicoureteral reflux. In addition, transperineal VUS can be helpful in evaluation of post-urethral lesions.</p>

Classifying of hilar cholangiocarcinoma: a comparison study between percutaneous ultrasonic cholangiography and percutaneous transhepatic cholangiography / 中华超声影像学杂志

Objective To evaluate the accuracy and utility of percutaneous ultrasonic cholangiography in Bismuth staging of hilar cholangiocarcinoma. Methods Thirty patients who underwent surgery and obtained pathologic diagnosis of hilar cholangiocarcincoma were perspectively ruled in this study. All patients with hilar obstruction underwent baseline ultrasound (BUS), percutaneous ultrasonic cholangiography (PUSC) and percutaneous transhepatic cholangiography(PTC) respectively. Taking operative findings as reference standard,the accuracy of the three imaging modalities in staging of hilar cholangiocarcinoma was compared. Results Among 30 patients, the accuracy of classification among BUS, PUSC and PTC was 23.3 % (7/30), 73.3 % ( 22/30 ), 73.3 % (22/30), respectively. There was statistically significant difference between BUS and PUSC, but the difference between PUSC and PTC was not statistically significant.Conclusions As a new technique for cholangiography, PUSC expands the application of ultrasound in evaluating hilar cholangiocarcinoma and is comparable to PTC in classifying hilar cholangiocarcinoma by Bismuth classification.

The preparation of sulfur hexafluoride lipid-coated microbubbles / 中华超声影像学杂志

Objective To prepare phospholipid-based sulfur hexafluoride gas-filled microbubbles, which were designed for targeting microbubbles. Methods The microbubbles composed of DSPC and mPEG2000-PE were produced by film-sonication method,and were compared with SonoVue. In the physical chemistry characteristics studies, the morphology, particle diameter, concentration, pH value and osmotic pressure were investigated. In the echogenicity studies, contrast harmonic imaging technique was used to investigate the enhancement of vitro water sac and normal rabbit kidney parenchyma. Results The lipid microbubbles were well-distributed, round with air holes. The average diameter of self-made microbubbles and SonoVue were 2.25 μm and 2.50μm respectively. The average diameter of self-made microbubbles and SonoVue distributed from 0.4 μm to 10 μm and 0.2 μm to 10 μm,and 90% were under 6 μm and 8 μm respectively,the concentration were 5 x 108～10 x 108/ml and 1 x I08～5 x 108/ml respectively with a stability of 6 hours. In vitro water sac, the gray scale of self-made lipid microbubbles and SonoVue were 121.67±6.76 and 122.33 ± 4.53 respectively( P>0.05). In normal rabbit kidney parenchyma, the peak video intensity of normal rabbit kidney parenchyma of self-made lipid microbubbles and SonoVue were 72.00 ± 7.21 and 74. 65± 10.93 respectively(P>0.05). Conclusions The lipid microbubbles have satisfactory physical chemistry characteristics and echogenicity.

The value of ultrasonic cholangiography with contrast agent SonoVue:primary experience ZHOU Lu-yao, / 中华超声影像学杂志

Objective To evaluate the feasilibility of ultrasonic cholangiography(USC)with contrast agent SonoVue in evaluating the obstructive bile duct diseases.Methods Twenty patients with obstructive jaundice(choledocholithiasis in 4,post-operative biliary strictures in 2 and malignant tumors in 14)underwent uhrasound-guided percutaneous transhepatic cholangiodrainge drainage(PTCD).Afterward,USC with contrast agent SonoVue administrated from the PTCD tube and percutaneous transhepatic cholangiography(PTC)were carried out in each patient.By using the surgical or PTC findings as reference standard,accuracy of USC in determining the obstructive level and cause of bstructive was evaluated.Results ①The visualization of contrast agent SonoVue was successfully obtained in all 20 patients,three order of bile duct was visualized in 19 patients.The visualization of the ultrasound contrast agent persisted more than 6 min.There was no side effect occurred during the procedure and no uncomfortable complaint after the procedure.②USC determined correctly in 18 cases.Compared with surgical or PTC findings,the accuracy of USC in determining obstructive levels was 90.0%(18/20),and the accuracy in determining the obstructive cause was 85.0%(17/20).Conclusions As a new and safe technique for cholangiography,USC is comparable to PTC in displaying the intrahepatic bite duct and determining the obstructive levels in patients with obstructive jaundice.