Ultrasound analysis for pancreatic panniculitis: A case report / 中南大学学报(医学版)

Pancreatic panniculitis (PP) is a necrotizing inflammation of subcutaneous fat that is a rare complication of pancreatic disease appearing in 2% to 3% of all patients. It is more common in the elderly and often affects the extremities. It presents as skin inflammation with pain and erythema nodules. We report a case of acute pancreatitis associated with PP in an old female. She was admitted for vomiting and abdominal pain for 3 days and presented with a 2-week history of erythematous subcutaneous nodules on her legs. Laboratory and ultrasonic findings revealed acute pancreatitis. High frequency ultrasound showed hypoechoic foci in subcutaneous soft tissue layer and adipose layer. Histopathological examination confirmed the diagnosis of PP. Nodules disappeared with the resolution of acute pancreatic inflammation. PP may be the first manifestation of pancreatic disease. Imaging features of this pathology are seldom described and ultrasonic diagnosis experience is worth to be accumulated.

Analysis of the causes of misdiagnosis of gallbladder adenomyoma by ultrasound / 中华超声影像学杂志

Objective:To analyze the factors of missed diagnosis and misdiagnosis of gallbladder adenomyomatosis(GBA) by ultrasonography according to the contrast between ultrasonography and pathology.Methods:Four hundred and forty-six cases of patients with pathological diagnosis of GBA and complete preoperative case informations were retrospectively collected from January 2010 to November 2018 in the PLA General Hospital, and the preoperative ultrasound diagnosis, clinical symptoms, pathological classification were analyzed. The coincidence rate and missed diagnosis rate of GBA by ultrasound were calculated. The ultrasonic diagnosis of GBA missed diagnosis and misdiagnosis factors were analyzed according to the multiple factors and single factor Logistic regression.Results:The coincidence rate of ultrasonic diagnosis was 46.9%(200/426), the missed diagnosis rate was 35.2%(150/426), and the misdiagnosis rate was 17.8%(76/426). Misdiagnosed cases included 65 cases (85.5%) of gallbladder occupation, 7 cases (9.2%) of gallbladder stones, and 4 cases (5.3%) of chronic cholecystitis. The results of multi-fact OR Logistics regression analysis showed that gallbladder stones ( OR=5.112, P<0.001), chronic cholecystitis ( OR=4.613, P<0.001), gallbladder occupation ( OR=6.565, P<0.001) and cholesterol crystals ( OR=8.634, P<0.001) were independent influencing factors for accurate diagnosis of GBA by ultrasound. Conclusions:Ultrasound has a high rate of missed diagnosis and misdiagnosis for GBA operation group at present. Since most cases are complicated with other gallbladder diseases, it is important to scan carefully for GBA besides the diagnosis of a single gallbladder disease.

Research progresses of three-dimensional reconstruction and printing techniques in breast neoplasms / 中国医学影像技术

Currently,medical imaging (ultrasound,mammography,CT,MRI) is of great value in diagnosis of breast lesions,and has a high sensitivity and accuracy in qualitative diagnosis.Based on medical imaging and with the rapid development,three dimensional (3D) printing and 3D reconstruction techniques can provide more information about accurate position,anatomical structures,morphology and volume of lesions and so on.And it is helpful in efficient communication with patient,making precise surgical plan,postoperative individual reconstruction and assessment of the effect after chemotherapy.The progresses of 3D reconstruction and printing techniques based on medical imaging in diagnosis of breast lesions were reviewed in this paper.

Value of Contrast-enhanced Ultrasound and Conventional Ultrasound in the Diagnosis of Papillary Thyroid Carcinoma with Cervical Lymph Node Metastases / 中国医学科学院学报

Objective To compare the ultrasound features of papillary thyroid carcinoma with or without cervical lymph node metastasis (LNM). Methods Patients suspected of thyroid cancer underwent the conventional ultrasound and contrast-enhanced ultrasound (CEUS) examinations. Patients' age,sex,and ultrasound characteristics of lesions were recorded. With the surgical pathology as the golden standard,the ultrasound features were compared between the cervical LNM group and non-LNM group. Results Of 144 patients,51 had cervical LNM and 93 did not. Patients' ages,sex and number of lesions had no significant difference between two groups (all P>0.05). Tumor with LNM had maximum size greater than 0.85 cm,ill-defined margin (P=0.000),irregular shape (P=0.007),internal heterogeneous echogenicity (P=0.007),microcalcification (P=0.020),internal heterogeneous low-enhancement (P=0.002),peripheral non-enhancement ring (P=0.030),and extracapsular extension (P=0.000). Conclusion Conventional ultrasound and CEUS are helpful for predicting the cervical LNM of PTC. CEUS can obtain more accurate diagnostic results for the extracapsular extension,which contributes to the prediction of cervical LNM.

Clinical value of thermal tomography in diagnosis of breast diseases / 医疗卫生装备

Objective To explore the clinical value of thermal tomography (TT) in the diagnosis of breast diseases.Methods Totally 222 breast diseases patients underwent examinations by color Doppler ultrasound and TT.Some stable TT images were selected,and the TT curves of the lesions were analyzed according to the malignant tumor TT curve diagnosing standard,so that the benign and malignant tumors could be determined.Color Doppler ultrasound was used to describe the site,size and property of the lesion.Results Pathological examination found 95 cases of malignant tumors and 127 benign ones.TT had 198 results coincident with those by pathological examination while the remained 24 ones not,with 15 false positive results and 9 false negative ones.When compared with pathological examination,TT had the accuracy,sensitivity and specificity being 89.19％,90.43％ and 88.28％ respectively.Conclusion TT is non-invasive,accurate and sensitive when used to screen and diagnose breast diseases,and should be applied if possible in medical facilities.

Prognosis and Inlfuencing Factor of Hematoma Complicated from Ultrasonography-guided EnCor Vacuum-assisted Breast Biopsy System in Minimally Invasive Surgery for Breast Lesions / 中国医学影像学杂志

Purpose To investigate the prognosis and influencing factor of hematoma complicated from ultrasonography-guided EnCor vacuum-assisted breast biopsy system in minimally invasive surgery for breast lesions, and to provide reference for clinical treatment. Materials and Methods 280 female patients with 486 benign breast lesions underwent minimally invasive excision using a ultrasonography-guided EnCor vacuum-assisted device, occurrence and the inlfuence factors of hematoma complicated from the operation was observed. Results All the 486 lesions were completely excised with EnCor system, hematoma (≥1cm) were found in 47 cases after 24 hours and almost disappeared in 6 months. After analysis of the occurrence of hematoma, it was found that the following situations would lead to a higher incidence of hematoma, which included lumps ≥ 2.5 cm, more than two lesions removed at one time, lumps locating deep inside the areola or the edge of breasts, bigger and less dense breasts, operation in menstrual period, pressure bandaging after operation less than 12 hours and operation without using adrenaline (P<0.05 or P<0.01). Conclusion Benign lesions breast can be effectively excised using ultrasonography-guided EnCor vacuum device, and the factors listed below could affect the occurance of hematoma complicated from the surgery, including the size, location and number of the resected nodules, breast shape, surgery during menstrual period, postoperative pressure bandaging and the use of hemostatics.

Value of the shear wave elasticity in the diagnosis of benign and malignant breast lesions / 中华超声影像学杂志

Objective To evaluate the value of supersonic shear wave elastrography(SWE) in the diagnosis of benign and malignant breast lesions.Methods SWE was performed on 134 breast lesions of 123 female patients and 74 normal breast glands to determine the values of overall elastic modulus and dispersion,and ROC curves were used to assess the diagnosis boundary value of two kinds of data respectively.Results According to the diagnostic gold standard-histopathology,the values of overall elastic modulus and dispersion were statistically significant when comparing benign lesions and malignant lesions with normal glands.ROC curve displayed that,when the Youden index reached to maximum,the diagnosis boundary value of overall elastic modulus was 41.01 kPa,the sensitivity and specificity of the value were 68.5％ and 83.8％ respectively; the diagnosis boundary value of dispersion was 12.25 kPa,the sensitivity and specificity of the value were 87.0％ and 88.7％ respectively.Conclusions The values of overall elastic modulus and dispersion for solid breast lesions can be used to reflect the elastic characteristics of lesions quantificationally,which is useful to diagnose benign and malignant breast lesions in clinical.

Clinical study of raise ultrasonic display rate for calcification in breast lesions / 中华超声影像学杂志

ObjectiveTo evaluate the value of MicroPure software system in the display of calcification and diagnostic accuracy of breast carcinoma.MethodsSixty-three patients with 68 breast lesions were checked by conventional ultrasound,X-ray and MicroPure software technique.The calcification was described and the lesions were classified with BI-RADS.All cases were pathologically confirmed by biopsy or operation.Results ①Compared to the detection rate for calcification of X-ray,the display rate of conventional ultrasound was 80.6% ,and the display rate of MicroPure software technique was 100%.②The area under the curve of diagnosing benign and malignant of breast lesions was 0.916,0.857 and 0.970 respectively with ultrasound,X-ray and MicroPure software technique.③Three lesions was classified Ⅲ in BI-RADS with conventional ultrasound,and Ⅳ in BI-RADS with MicroPure software.The pathologic results were malignant.ConclusionsMicroPure software system obviously raised the ultrasonic display rate of calcification,meanwhile,it raised the diagnostic accurate rate of breast cancer.It especially raised the tendency rate for the patients who were classified between Ⅲ and Ⅳ in BI-RADS.

Percutaneous injection of hemostatic agents under the guidance of contrast-enhanced ultrasound for grade Ⅲ-Ⅳ hepatic trauma / 中华超声影像学杂志

Objective To explore the value of percutaneous injection of hemostatic agents under the guidance of contrast-enhanced ultrasound(CEUS)for grade Ⅲ-Ⅳ hepatic trauma patients.Methods Eleven patients with severe hepatic trauma were treated using percutaneous focal injection of hemostatic agents.Five of these patients were hepatic injury of grade Ⅲ,and others were grade Ⅳ according to AAST.Results Out of all patients with severe hepatic trauma,9 patients were cured by once percutaneous injection of hemostatic agents under the guidance of CEUS,and 1 patient was cured by twice injection,and 1 patient was switched to surgery because of complicated pancreatic injury and the increase of free intraperitoneal fluid.Conclusions CEUS can display the site and severity of liver injury.Combining with interventional technology,injection of hemostatic agents under the guidance of CEUS can save life and avoid to resect organ,and it can win time for treating other compound injury.

Localization diagnosis of insulinoma by contrast-enhanced ultrasonography compared with laparoscopic ultrasonography / 中华超声影像学杂志

Objective To compare the value of contrast-enhanced ultrasonography (CEUS) with that of laparoscopic ultrasonography (LUS) in localization diagnosis of insulinoma. Methods Thirty-three patients with insulinoma,who received operation, were retrospectively reviewed. All cases were examined by both CEUS and LUS before the tumor removed. Both imaging modalities in diagnosis of insulinoma were analyzed. Results By this study the sensitivity and accuracy of CEUS were 92.31% and 90.0% respectively. Those of LUS were consistent with pathologic findings completely. The accuracy of CEUS was not different with that of LUS (χ2 = 4.21, P = 0. 04). Conclusions CEUS can be used for location diagnosis of insulinoma. For the patients expecting laparoscopic treatment, combination of CEUS with LUS will be suggested before insulinoma is removed.

Preliminary study of VACORA vacuum-assisted rotation system in the treatment of benign breast lesions / 中华超声影像学杂志

Objective To study the clinical value of VACORA vacuum-assisted rotation system in the treatment of benign breast lesions. Methods Under the screening of dynamic ultrasound,122 beast lesions in 93 patients diagnosed as benign lesions from ultrasound were treated with VACORA vacuum-assisted rotation system,and all the patients were examined for follow-up. Results All the lesions were totally rotated and 119 lesions demonstrated to be benign and 3 lesions were atypical hyperplasia from pathologic examination. In the benign lesions, 72 cases were demonstrated to be fibroadenoma, 39 cases were demonstrated to be fibrosis adenosis,4 cases were intraductal papilloma,2 cases were duct inflammation, 1 case was epithelial hyperplasia of the duct and 1 case was lymphode. In 8 cases,bleeding was seen along the needle tract,which was stopped after compression. Small hematoma was formed in 10 patients in the second day of follow-up, which was disappeared in the 3 to 6 months of the follow-up. And all patients had no remnant lesions in the local area and the incisions were not clear in the skin 3 to 6 months of the follow-up. Hypoechoic focuses were detected out at the original location in the 3 benign cases, which were possibly residual focuses. Conclusions Benign breast lesions could be clearly resected with VACORA rotation system under the screening of ultrasound, which is safe, minimal invasive, prosthetic, and has little complications.

Correlation between grey scale ultrasonographic feature and estrogen receptor, progesterone receptor and human epidermal growth factor receptor-2 expression in infiltrating ductal cancer of breast / 中华超声影像学杂志

Objective To evaluate the relationship between the grey scale ultrasonographic feature and estrogen receptor(ER),progesterone receptor(PR)or human epidermal growth factor receptor-2(HER-2)expression in infiltrating ductal cancer(IDC)of breast.Methods Seventy-three patients with IDC confirmed pathologically were involved in this study.The specimens wete examined immunohistochemistically to judge the expression of the related factors.ER,PR and HER-2 expression of the mastectomy specimens were determined with immunohistochemical staining technique.The correlation between the ultrasonographic features and ER,PR or HER-2 positive expression was analyzed. Results The ER positive rate in lesions with the spicule sign,echogenic halo or posterior shadowing were higher than in lesions without the spicule sign,echogenic halo or posterior shadowing(P＜0.01).The HER-2 positive rate in lesion with the calcifications and lymphadenectasis in axillary was higher than that in lesions without calcifications,or lymphadenectasis in axillary(P＜0.05).Conclusions A certain correlation exists between the ultrasonographic features and ER,HER-2 expression in patients with IDC.

Combination of the contrast-enhanced ultrasound and color Doppler's grade to diagnose breast masses / 中华超声影像学杂志

Objective Comparing the enhancement of contrast-enhanced ultrasound(CEUS) with the intensity of the blood signals of breast masses, and producing the parameter of peak intensity (PI), to determine whether they can reflect the differentiation of the benign breast masses from the malignant ones.Methods Fifty patients with the breast masses (25 benign,25 malignant) were implemented the contrastenhanced ultrasound inspection.The blood signals of the masses could be got before performing the CEUS,then the CEUS was performed.The enhancement of the masses was divided into 4 grades according to the enhancement of breast which was around the mass (no enhancement, low enhancement, equal enhancement,and high enhancement as well).The PIs of all masses and high enhanced massed were calculated by software in machine,then them were compared according to "the groups which had been classified by their maximal diameters.Results Forty-one of 50 cases showed an obvious enhancement using CEUS compared with the routine CDFI.Malignant masses were more obviously than that of benign ones ( P＜0.05).In the 50 cases,the no enhanceed ones( n = 2) and equal enhanced ones( n = 5) were benign,and 1 case of the low enhanced masses( n = 9) was malignant.The high enhanced masses ( n = 34) were malignant or benigh.About the high enhanced masses, there were statistics meanings using the parameter of PI for the masses whose maximal diameters＜2 cm( P＜0.05),and no statistics meanings when their maximal diameters≥2 cm(P＞0.05).Conclusions The CEUS of breast can improve the appreance of the tumor' s blood vessel obviously, especially for malignant masses.The PI of the breast benign masses are different from the malignant ones.Combination of them can help to discriminate benign masses from malignant ones.The parameter of PI is useless for differentially diagnosing the breast masses if their maximal diameters≥2 cm and the blood flow grade Ⅲ before CEUS.

The value of gray scale contrast-enhanced ultrasonography in diagnosing active hemorrhage of the kidney:an animal experiment / 中华超声影像学杂志

Objective To evaluate the diagnostic value of gray scale contrast-enhanced ultrasonography(CEUS) in the diagnosis of active hemorrhage of the kidney.Methods Forty-six active hemorrhage animal models were created within the kidney of 23 New Zealand rabbits heparinized under general anesthesia,rabbit kidneys were examined by routine two dimensional ultrasonography and CEUS.Results Routine ultrasonography showed 26 traumas with irregular and poorly defined margins.CEUS showed all active bleeding sites,contrast agents overflowed from injured blood vessel and formed irregular remarkable enhanced parts.After average 85s for contrast agent was injected,the intensity of the enhanced regions in the kidneys were significantly higher than those of normal renal parenchyma.Conclusions CEUS could clearly demonstrate the active hemorrhage in traumatic kidney and could significantly improve the diagnostic level of ultrasonography.

Evaluation of the facial artery and vein using color Doppler imaging / 中华整形外科杂志

<p><b>OBJECTIVE</b>The purpose of this study was to provide the guidelines with respect to the location of the facial vessels, observe the potential reversed flow of the facial artery, and reemphasize the value of color Doppler ultrasound studies in flap planning.</p><p><b>METHODS</b>A study was carried out to investigate the location and dynamics of the facial artery and vein using color Doppler ultrasonography in 12 adults.</p><p><b>RESULTS</b>The facial artery and the vein were located together at the lower border of the mandible. Around the oral commissure and under the nasal ala, they run apart from each other at variable distances. The reverse flow was observed in the 12 patients after the blood flow of the facial artery was blocked by applying pressure manually at the lower border of the mandible.</p><p><b>CONCLUSIONS</b>The divergence of the facial vein from the artery is important information in planning of axial pattern flaps. Observation of the reversed flow confirms the possibility of safe elevation of a retrograde flow-arterialized flap based on the distal portion of the facial artery.</p>

Clinical study of the hemodynamics of both ends (proximal and distal) of internal mammary artery and its following-up / 中华整形外科杂志

<p><b>OBJECTIVE</b>To verify the value of retrograde flow of Internal Mammary Artery (IMA) used as one of the supplying arteries and to develop a new method of applying IMA in breast reconstruction.</p><p><b>METHODS</b>During breast reconstruction with free bilateral transverse rectus abdominis myocutaneous (TRAM) flap, the pressures and velocities of the two ends (proximal and distal) of internal mammary artery as well as the according perfusion unit (PU) of TRAM were measured in two patients who suffered from mammectomy because of carcinoma.</p><p><b>RESULTS</b>The pressure at distal end was 66 or/and 58 mmHg, the pressure at proximal end was 88 or/and 75 mmHg, the former is 75%-77% of the later. The immediate rate of blood flow of distal anastomotic stoma was 74 or/and 52 ml/min, that of proximal was 94 or/and 70 ml/min, the former is 74%-78% of the later after anastomosed to the two sides of deep inferior epigastric arteries (DIEA) separately. Under condition that both ends (proximal and distal) of IMA contributing as the supplying blood vessels simultaneously, the PU of TRAM was the best. The rates of blood flow at the two anastomotic stomas are similar to each other in late stage (evaluated at the fifth year follow-up).</p><p><b>CONCLUSION</b>The distal end of internal mammary artery can supply blood flow in a considerable level, similar with the proximal end.</p>

Hepatic adenomas: comprehensive imaging diagnosis / 中华放射学杂志

Objective To describe the US, CT, and MR imaging findings and diagnosis of hepatic adenomas. Methods The comprehensive imaging features in 6 patients with 6 hepatic adenomas confirmed pathologically were reviewed retrospectively and correlated with pathologic findings. Results One case was diagnosed correctly, four cases were mistaken for hepatocellular carcinomas (HCC), and one case was mistaken for focal nodular hyperplasia. US: six lesions were hypoechoic with hypohalo in four lesions, and there was low velocity arterial and venous flow within the six lesions. CT: six lesions were hypodense with pseudocapsule in four lesions, and the four lesions showed slight enhancement during arterial and portal venous phases, and one lesion showed moderate enhancement during arterial phase and slight enhancement during portal venous phase. MRI: six lesions had heterogeneously high signal intensity on T 1WI and T 2WI, and the high intensity on T 1WI remained unchanged after using fat saturation. Two lesions showed strong enhancement during arterial phase and slight enhancement during portal venous and delayed phases, and three lesions showed slight enhancement during arterial, portal venous, and delayed phases. Pseudocapsule detected in six lesions showed slight enhancement on portal venous or delayed phases. Conclusion The comprehensive imaging findings of hepatic adenomas were nonspecific. The presence of pseudocapsule, heterogeneous high signal intensity on T 1WI, and the high intensity remained unchanged after using fat saturation may help make a correct diagnosis of hepatic adenoma.

Ultrasound densitometry analysis of human carotid plaque components / 解放军医学杂志

Objective To correlate the ultrasound imaging of atherosclerotic carotid in vivo and in vitro with the histological analysis, and to evaluate the usefulness of gray scale ultrasound densitometry analysis of ultrasound images. Methods Twenty-two carotid plaque lesions of 20 patients were examined by high resolution B-mode ultrasound pre- and post operatively, and the images of carotid plaque were quantitatively analyzed by 256 gray scale ultrasound densitometry. The transverse pathological sections of the plaques were made, and matched and compared with the images of ultrasound. Results Ultrasound density measurement of calcium, fibrous tissue, hemorrhage / thrombus and lipid deposits was 89?12, 53?8, 37?6, and 39?3 respectively in vivo, and was 168?11, 136?12, 85?12 and 89?10 respectively in vitro. Besides the comparison between hemorrhage and lipid deposits, there were significant statistic differences of density measurement between different components. Conclusions Gray scale ultrasound densitometry analysis can provide quantitative measurement of atherosclerotic carotid plaque, and is useful for evaluate the stability of the plaque.

The value of intraoperative ultrasonography in judging the resectability of central bronchogenic carcinoma: a comparison with computed tomography / 解放军医学杂志

Objective To evaluate the accuracy of intraoperative ultrasonography (IUS) in judging the relationship between central bronchogenic carcinoma and pulmonary vessels and in predicting the resectability of the tumor. Methods Intraoperative ultrasonograpy(IUS) and preoperative CT scanning were performed in 30 patients of central bronchogenic carcinoma. The relationship between vessel and tumor as assessed by IUS and preoperative CT were quantified and scored with a ranging from 0-4 respectively, and then the resectability of the tumor and optimal surgical method were predicted according to the scores. Results The accuracy of CT and IUS to determine tumor-vessel relationship was 72.3%(141/195) and 81.0%(171/211), respectively (P=0.037). The sensitivity of CT and IUS in predicting the resectability of tumor was 91.3%(21/23) and 95.6%(22/23), respectively, the specificity was 28.6%(2/7) and 57.1%(4/7), respectively, and the accuracy was 76.7%(23/30) and 86.7%(26/30), respectively. The accuracy of CT and IUS in predicting surgical strategy was 53.3%(16/30) and 63.3%(19/30), respectively(P=0.432). Conclusion IUS is a useful method in predicting the resectability of centrally located bronchogenic carcinoma.

DETECTION OF LYMPHATIC METASTASIS OF LUNG CANCER BY INTRAOPERATIVE ULTRASONOGRAPHY / 解放军医学杂志

Objective To evaluate the value of intraoperative ultrasonography (IUS) in detecting the lymph nodes in mediastinum and hilum during lung cancer surgery. Methods Lymph nodes were detected in every part of the mediastinum and hilum by IUS in 33 cases with lung cancer during surgery. The number, size and location of lymph nodes were recorded, and the metastasis to lymph nodes was predicted by the sonographic features and geometric measurement respectively. Mediastinum was explored and lymph nodes resection was performed in each case, and each resected lymph node was sent for pathological examination. Results The sensitivity of IUS in detecting lymph nodes in mediastinum and hilum was 83.6% (163/195) and the positive predictive value was 97.0%(165/168). The result of detecting lymph nodes with IUS was influenced by their location and size. The sensitivity, specificity and accuracy of IUS in diagnosing lymphatic metastasis with respect to geometric measurement were 70.3%, 71.7%, 71.2%, respectively, and were 85.7%, 75.0%, 83.3%, respectively, with respect to sonographic features. Conclusions IUS was an effective method for lung cancer surgery in detecting mediastinum lymph nodes.