Clinicopathologic features and imaging manifestations of focal nodular hyperplasia-like nodules in cirrhosis liver / 中华肝胆外科杂志

A kind of focal lesions called focal nodular hyperplasia-like nodules (FNH-LNs) was found in liver cirrhosis, especially in alcoholic cirrhosis, which is similar to focal nodular hyperplasia in histology. The imaging features of FNH-LNs show hyperenhancement in arterial phase, hypoenhancement in portal venous phase or delayed phase. FNH-LNs are easily misdiagnosed as hepatocellular carcinoma (HCC). With reviewing the relating articles in China and abroad, this article summarizes the etiology, clinicopathological features and imaging manifestations of FNH-LNs, so as to distinguish FNH-LNs and HCC in cirrhosis and guide selection of treatment.

Real-time shear wave elastography measurement of splenic elasticity in evaluation of liver cirrhosis with portal hypertension / 中国医学影像技术

Objective To investigate the diagnostic value of splenic elasticity measured with real-time shear wave elastography (SWE) in liver cirrhosis patients with portal hypertension.Methods Totally 64 cirrhotic patients with portal hypertension (PH group) and 62 liver cirrhosis patients without portal hypertension (control group) were enrolled.The elasticity,the thickness and the length of the spleen of both groups were compared.The areas under the ROC curve (AUC) of the SWE elasticity,the thickness and the length of the spleen were compared with a DeLong test.The optimal cutoff value of SWE elasticity was obtained,and the sensitivity and specificity were calculated,respectively.Results The differences of the SWE elasticity,the thickness and the length of the spleen between the two groups were statistically significant (all P＜0.001).AUC of SWE elasticity,thickness and length of the spleen was 0.979 (95％ CI[0.944,0.989]),0.917 (95％CI [0.854,0.926] and 0.865 (95％CI [0.775,0.928]),respectively.The differences between each two parameters were statistically significant (all P＜0.05).The optimal cutoff value of the spleen SWE elasticity was 19.98 kPa,the sensitivity and the specificity was 95.78％ and 94.27％,respectively.Conclusion The diagnostic efficacy of spleen SWE elasticity was higher than that of spleen thickness and spleen length,therefore having better diagnostic value for liver cirrhosis patients with portal hypertension.

Ultrasound features of hepatic inflammatory myofibroblastic tumor: a report of 4 cases / 临床肝胆病杂志

Objective To investigate the ultrasound features of hepatic inflammatory myofibroblastic tumor (HIMT).Methods A retrospective analysis was performed for the ultrasound features of 4 patients who visit Shengjing Hospital from February 2007 to July 2017 with pathologically confirmed HIMT,including the location,size,boundary,morphology,internal echo,and blood flow of lesions.Results The patients were aged 2-69 years and there were 2 male and 2 female patients.All 4 patients had single tumor with a maximum diameter of 3.4 -21.2 cm.Two patients had clear boundaries and two had unclear boundaries.Two patients had solid tumor with inhomogeneous low echo and 2 had mixed cystic and solid type;color Doppler flow imaging found blood flow signal in tumor in all patients.Conclusion Ultrasound can clearly reveal the size,internal echo,and blood flow of HIMT,but the ultrasound images of HIMT lack specificity.Pathological examination is still needed for a confirmed diagnosis.

Contrast-enhanced ultrasonography appearances of intrahepatic peripheral cholangiocarcinoma / 中华超声影像学杂志

Objective To investigate the contrast-enhanced ultrasonography appearances characteristics of intrahepatic peripheral cholangiocarcinoma( ICC) and to improve the diagnosis level of ICC on contrast-enhanced ultrasonography . Methods Thirty cases with ICC confirmed by pathological examinations of surgeries were retrospectively analyzed for findings of ultrasonography , clinic and pathology ,to explore the typical contrast-enhanced ultrasonography appearances and the correlation with pathological differentiation . ResultsOn contrast-enhanced ultrasonography , 30 lesions showed enhancement on the arterial phase and appeared hypo-echoic enhancement on the portal phase ,which displayed fast-in and fast-out" enhancement pattern . During the hepatic arterial phase of contrast-enhanced ultrasonography ,10 lesions showed peripheral enhancement ,10 lesions showed relatively homogeneous hyper-enhancement ,6 lesions showed heterogeneous enhancement ,2 lesions showed iso-enhancement ,and 2 lesions showed hypo-enhancement . To the 30 lesions ,the average initial time of enhancement was ( 18 .81 ± 4 .66)s (12 －28 s) ,the average time of washing-out was (36 .00 ± 12 .30) s (18 －60 s) . There was no significant difference in time of washing-in and washing-out among different pathological differentiation groups ( P＞0 .05) . Conclusions ICC often shows fast-in and fast-out" enhancement pattern on contrast-enhanced ultrasonography ,and the time of washing-out is generally in late arterial phase or early portal phase ,but there is no significant difference in time of washing-in and washing-out among different pathological differentiation groups .

Value of advanced dynamic flow versus color Doppler flow imaging in evaluating stent patency after transjugular intrahepatic portosystemic shunt / 临床肝胆病杂志

ObjectiveTo investigate the value of advanced dynamic flow (ADF) versus color Doppler flow imaging (CDFI) in evaluating stent patency after transjugular intrahepatic portosystemic shunt (TIPS). MethodsA total of 60 post-TIPS patients who underwent ADF, CDFI, and contrast-enhanced ultrasound (CEUS) in Shengjing Hospital of China Medical University from September 2016 to May 2018 were enrolled. The grade of the patency of TIPS stent was evaluated according to the results of ADF, CDFI, and CEUS. With the results of CEUS as the gold standard, the Kappa test was used to examine the consistency between ADF and CEUS results, as well as between CDFI and CEUS results, the Z test was used as the hypothesis testing of kappa value. ResultsThere was extremely strong consistency between ADF and CEUS in evaluating stent patency after TIPS (Kappa=0.902, P＜0.05), while there was moderate consistency between CDFI and CEUS in evaluating stent patency after TIPS (Kappa=0423, P＜0.05). The Z test found that the difference was statistically significant (P＜0.05). ConclusionCompared with CDFI, ADF has a higher value in evaluating stent patency after TIPS and has certain clinical significance.

The value of contrast-enhanced ultrasound guiding normal saline injection in the detection of residual common bile duct stones / 中华超声影像学杂志

Objective To investigate the diagnostic value of contrast-enhanced ultrasound (CEUS) guiding normal saline (NS) injection through endoscopic nasobiliary drainage duct(ENBD) on evaluation for residual stones in common bile duct.Methods Fifty-five patients with bile duct stones were treated by endoscopic retrograde cholangio-pancreatography (ERCP) and duodenoscopic sphincterotomy incision surgery (EST) and ENBD.All patients received normal ultrasonography and CEUS guiding NS injection ultrasonography after EST.The length and width of common bile duct and the detection rate of residual stones before and after NS injection were compared.Results In the 55 patients,1 patient failed in injection of contrast agent into the ENBD.In the other 54 patients,the difference of the length and width of common blie duct before and after NS injection were statistically significant [(2.94±1.76)cm vs (6.09±1.46)cm,(0.58±0.30)cm vs (1.11±0.98)cm](all P<0.001).The full display rate of the common bile duct before and after NS injection were 13.0%(7/54) and 90.7%(49/54),respectively.Before injection,none of common bile duct stones was suspected.After injection,5 cases of common bile duct stones were suspected.Three cases were confirmed by ERCP,1 case was confirmed by operation and 1 case was false positive.Conclusions CEUS of the common bile duct through ENBD performs its patency and course.On this basis the injection of NS increases the display rates of common bile duct,thus improving the detection rate of residual stones.

Evaluation of stent function after transjugular intrahepatic portosystemic shunt using color Doppler and contrast-enhanced ultrasound / 临床肝胆病杂志

At present,transjugular intrahepatic portosystemic shunt (TIPS) is an effective procedure widely used in the clinical treatment of portal hypertension.The blood stream in the portal vein can be directly shunted into the hepatic vein through the inserted stent,which helps to reduce portal vein pressure.TIPS provides treatment opportunities for the patients with advanced portal hypertension complicated by intractable ascites and gastroesophageal variceal bleeding and those who are waiting for transplantation or cannot tolerate surgery.The key to success of TIPS is to maintain stent patency after placement,and therefore,post-TIPS monitoring is of vital importance.As a noninvasive,cheap,practical,and repeatable procedure,ultrasound has an important value in post-TIPS monitoring.This article summarizes the role of color Doppler and contrast-enhanced ultrasound in evaluating stent function after TIPS.

Clinical Study on Observing Common Bile Duct Residual Stones by Saline Injection Through ENBD Under the Guidance of Ultrasound / 中国微创外科杂志

Objective To investigate the accuracy of observing common bile duct ( CBD ) residual stones by saline injection through endoscopic nasobiliary drainage ( ENBD ) under the guidance of ultrasound after endoscopic retrograde cholangiopancreatography (ERCP), endoscopic sphincterotomy (EST) and endoscopic stone extraction . Methods From October 2014 to August 2015, 58 patients with CBD stones received ENBD after endoscopic stone extraction .Ultrasound examination was performed on the 1-5 postoperative days .After routine examination by a professional ultrasound doctor , a total of 50-200 ml saline was injected through ENBD slowly at a rate of 100 ml/min.Ultrasonic results, including changes of bile duct diameter and detection rate of CBD residual stones , were compared before and after the injection . Results All the 58 patients were given ENBD cholangiography after endoscopic stone extraction .Among them, CBD residual stones were detected positive in 3 patients and negative in 55 patients by ENBD cholangiography .Among the 55 patients, CBD residual stones were detected in 1 patient by routine ultrasound which was confirmed after injection .Among the other 54 patients who were not detected stones by routine ultrasound , failure of injection occurred in 1 patient due to the damage of ENBD , and 2 patients showed bad tolerance of abdominal pain after injection of 20 ml saline and 3 patients were detected CBD residual stones after injection .While the other 48 patients were negative with CBD residual stones.For the 3 patients who were detected residual stones by cholangiography , routine ultrasound showed negative results but stones were detected after injection .Stone removal was achieved in 5 patients.The Youden index for CBD residual stones by saline injection through ENBD under ultrasound was 0.98, which was higher than cholangiography (0.4) and routine ultrasound (0.2).Among the 57 patients who underwent injection , obvious dilation of the diameter and length of the CBD was observed after injection in 56 patients (P<0.05). Conclusions For patients with ENBD, observing CBD residual stones by saline injection through ENBD under ultrasound has advantages of non-invasion, non-radiation, inexpensive cost , repeatedly checking and dynamic observation .It has a very important reference value in diagnosing CBD stones and proposes a new examination .

Value of contrast -enhanced ultrasound in evaluating peripancreatic vascular invasion and resectability of pancreatic cancer / 临床肝胆病杂志

Objective To investigate the value of preoperative contrast -enhanced ultrasound (CEUS)in evaluating peripancreatic vascular invasion and resectability of pancreatic cancer.Methods A retrospective analysis was performed for the clinical data of 25 patients with pancreatic cancer confirmed by surgical exploration or postoperative pathological examination,who visited Shengjing Hospital of China Medi-cal University from December 2012 to October 2014,and all the patients underwent CEUS before surgery.The relationship between the le-sion and the peripancreatic vessels was observed,the degree of invasion was evaluated,and related scores were measured.These results were compared with the results of intraoperative exploration and postoperative pathological results.The rate of peripancreatic vascular invasion, sensitivity and specificity of preoperative CEUS in evaluating the degree of peripancreatic vascular invasion,and sensitivity,specificity,pos-itive predictive value,negative predictive value,overall coincidence rate,and Youden index of CEUS in evaluating the resectability of pan-creatic cancer were calculated.Results Preoperative CEUS showed that 42 vessels were invaded,while intraoperative exploration showed 41 vessels were invaded.A total of 17 patients were considered resectable by CEUS,while 15 patients were considered resectable by intraop-erative exploration.In evaluating the resectability of pancreatic cancer,CEUS had a sensitivity of 93.3%,a specificity of 70.0%,an over-all coincidence rate of 84.0%,a false positive rate of 30.0%,a false negative rate of 6.7%,a positive predictive value of 82.4%,a nega-tive predictive value of 87.5%,and a Youden index of 0.633.Conclusion Compared with intraoperative exploration,CEUS has higher sensitivity and specificity in evaluating the degree of peripancreatic vascular invasion and higher sensitivity,specificity,and coincidence rate in evaluating the resectability of pancreatic cancer.CEUS can accurately evaluate the degree of peripancreatic vascular invasion and provides a new method for preoperative evaluation of the resectability of pancreatic cancer.

Value of contrast-enhanced ultrasound in differential diagnosis of single metastatic liver cancer and solitary necrotic nodule of the liver / 临床肝胆病杂志

ObjectiveTo investigate the value of contrast-enhanced ultrasound (CEUS) in the differential diagnosis of single metastatic hepatic carcinoma (MHC) and solitary necrotic nodule of the liver (SNNL). MethodsA retrospective analysis was performed for 12 patients with single MHC and 16 patients with SNNL who showed circular enhancement in arterial phase on CEUS. Age, size of lesion, and findings of two-dimensional gray-scale ultrasound and CEUS were compared between the two groups. The two-independent-samples t-test was used for comparison between groups, and the paired t-test was used for comparison within each group. ResultsThe MHC group had a significantly higher mean age than the SNNL group (60.2±11.3 years vs 41.0±9.1 years, t=4.970, P＜0.001). The mean diameter of lesion was 2.86±1.22 cm in the MHC group and 2.97±0.96 cm in the SNNL group, and showed no significant difference between the two groups (t=-0.269, P=0.790). In the MHC group, the lesions had complex and uneven echoes and blurred boundaries, while in the SNNL group, most lesions were in the right lobe and were hypoechoic with clear boundaries. No blood flow signals were detected on CDFI in these two groups. Both groups had circular enhancement around the lesions in arterial phase on CEUS, and the mean thickness showed a significant difference between the MHC group and the SNNL group (5.00±1.69 mm vs 2.37±0.87 mm, t=5.374, P＜0001). In the MHC group, the area in lesions without enhancement in delayed phase was significantly larger than that in arterial phase (t=-4.508, P=0001), while in the SNNL group, the area in lesions without enhancement showed no significant difference between delayed phase and arterial phase (t=-0.449, P=0.660). ConclusionThe thickness of circular enhancement in arterial phase on CEUS and the presence or absence of the enlargement in the area without enhancement contributes to the differential diagnosis of single MHC and SNNL.

Diagnostic value of contrast-enhanced ultrasonography for solitary necrotic nodule of the liver / 临床肝胆病杂志

ObjectiveTo summarize the imaging characteristics of solitary necrotic nodule of the liver (SNNL) on contrast-enhanced ultrasonography (CEUS) and to investigate the role CEUS plays in the diagnosis and differential diagnosis of SNNL. MethodsTwenty-five lesions of 23 cases diagnosed with SNNL by CEUS were retrospectively analyzed for findings of ultrasonography and contrast enhancement. ResultsFive patients were confirmed with SNNL by pathological examination of surgically resected liver tissue; necrotic nodule was confirmed in 18 patients by ultrasonographic follow-up or other imaging methods (contrast-enhanced computed tomography or contrast-enhanced magnetic resonance imaging). In 12 of the 25 SNNL lesions, no contrast agent enhancement was observed in all phases; 13 lesions showed thin-ring enhancement around the lesions on the arterial phase images and iso-enhancement with the liver on the portal and delayed phase images without enhancement inside the lesions in all phases. ConclusionThe typical imaging of SNNL on CEUS is no enhancement of the whole lesion in all phases or thin-ring enhancement around the lesion with no enhancement inside the lesion in all phases, which is helpful for the differentiation from other space-occupying lesions of the liver.

Diagnostic Value of Contrast-enhanced US for Kidney Tumor:A Meta-analysis / 中国医学影像学杂志

Purpose To review English and Chinese literatures on diagnosing kidney tumor using contrast enhanced ultrasound (CEUS). Materials and Methods CEUS and kidney tumor were selected as the key words to search CNKI, Wanfang data, CBMDisc, VIP, Embase, the Cochrane Library and PubMed from March 2009 to March 2014. According to evidence-based medicine requirements, heterogeneity test and quality evaluation were performed to evaluate the literature that met the inclusion criteria. The pooled sensitivity, specificity and diagnostic odds ratio (DOR) of included literature were calculated to determine summery receiver operating characteristic curve (SROC), and calculated the area under the curve (AUC) as well as Q index. Results A total of 12 studies met the inclusion criteria, including 9 in Chinese and 3 in English. Heterogeneity test showed a low heterogeneity among the literature, thus fixed effect models used. The pooled sensitivity was 0.95 (95%CI 0.93-0.96), specificity was 0.79 (95%CI 0.73-0.84), DOR was 76.36 (95%CI 41.73-139.71), Q index was 0.9208, and SROC AUC was 0.9706. Conclusion CEUS has high diagnostic value and accuracy for kidney tumors, which can provide imaging information for clinical decision.

Logistic Regression Analysis of Gallbladder Lesions of≥1 cm in Diameter Diagnosed by Ultrasound / 中国医学影像学杂志

Purpose To establish Logistic regression model of gallbladder lesions of≥1 cm in diameter diagnosed by ultrasound, and to filter benign and malignant sonographic features. Materials and Methods The sonographic features were retrospectively analyzed in 165 patients with gallbladde apophysis lesions of≥1 cm in diameter which confirmed by pathology, including the number of lesions, size, shape and basal width, gallstones, continuous gallbladder wall continuous, blood flow signals detected by color Doppler flow imaging. Logistic regression model with bipartition was established by multivariate Logistic regression analysis, and the efficiency of Logistic regression model was evaluated to predict benign or malignant of these lesions. Results Three characteristic variables, including lesion morphology, basal width and flow signals, were took into the Logistic regression model by binary Logistic regression analysis, which was the sensitive indicators can differentiate the benign or malignant gallbladder lesions. The accuracy, sensitivity and specificity of this model were 97.0%, 93.8%and 97.3%for predicting the benign or malignant gallbladder apophysis lesions≥1 cm in diameter, respectively. Area under ROC was 0.979. Conclusion Binary Logistic regression analysis can filter the sonographic features which can differentiate the benign or malignant gallbladder apophysis lesions≥1 cm in diameter, and lesion morphology, basal width and flow signals are of important differential diagnosis value of benign lesions or malignant lesions.

Study of gallbladder adenomas with contrast-enhanced ultrasound / 中华超声影像学杂志

lusionsThe CEUS findings are different between benign and malignant gallbladder adenomas. The enhancement pattern and speed are useful for differentiating benign from malignant adenomas.

Three-dimensional ultrasonography of normal vascular structures and vascular diseases / 中华超声影像学杂志

Objective To assess the clinical value of three-dimensional ultrasonography (3DUS) in normal vascular structures and vascular diseases. Methods Thirty-nine 3DUS images were reconstructed,including 17 normal vascular structures and 22 vascular diseases. 3DUS reconstruction was introduced by the maximum intensity projection (MIP) method. A series of 3DUS image was performed using GE Logiq 500 and Logiq 700. Results In all cases, 3DUS images were constructed within 10-30 seconds after free hand scanning. Internal, external and common carotid arteries were also showed in the same rotating 3DUS display simultaneously. The continuity of the transplanted hepatic portal vein were demonstrated clearly in rotating mode 3DUS display and consistent with angiography or computer tomography findings. In cases of various vascular diseases, the degree and location of stenosis or aneurysm of the vessels could be stereoscopically visualized, easy to understand especially for a surgeon who evaluates a preoperative state. Conclusions The 3DUS can display normal or abnormal vascular anatomy clearly. 3DUS image could supply more information than original two-dimensional image, and is useful in the diagnosis of various vascular diseases.