Clinical value of endorectal ultrasonography in predicting neoadjuvant treatment response for locally advanced rectal cancer / 中华超声影像学杂志

To assess the value of endorectal ultrasonography ( ERUS ) in predicting the pathological response to neoadjuvant chemoradiotherapy( NCRT ) for locally advanced rectal cancer( LARC) . Methods Ninety‐nine patients with LARC received NCRT and total mesorectal excision in our hospital were retrospectively analyzed . T he maximum length and thickness of rectal tumor were measured by ERUS both before NCRT ( ERUS1 ) and after NCRT following sugery ( ERUS2 ) ,and the length and thickness reduction rate were calculated . T he patients were classified into good responder group ( n ＝ 47 ) and poor responder group( n ＝ 52 ) ,or pathological complete response ( pCR) group ( n ＝ 25 ) and non‐pCR group ( n＝74) according to pathological tumor regression grade ( T RG ) . T he differences of various parameters were compared between groups . T he correlations between these parameters and T RG grading were analyzed by Spearman correlation analysis . T he ROC curve was used to evaluate the diagnostic efficacy of the parameter . Results T he length and thickness of ERUS2 were significantly shorter than that of ERUS1( all P ＜0 .05) . T he length and thickness of ERUS2 in good responder group were shorter than those in poor responder group ,while the length and thickness reduction rate were higher than those in poor responder group with significant difference ( all P ＜ 0 .05 ) . T he length and thickness of ERUS2 in pCR group were shorter than those in non‐pCR group ,w hile the length and thickness reduction rate were higher than those in non‐pCR group with significant difference ( all P ＜ 0 .05 ) . T he length and thickness of ERUS2 were positively correlated with T RG grading ( r ＝ 0 .577 ,0 .605 ; all P ＜ 0 .01 ) and the length and thickness reduction rate were negatively correlated with T RG grading ( r ＝ －0 .681 ,－0 .598 ; all P ＜0 .01 ) . ROC curve showed the cut‐off value of the length and thickness reduction rate to predict good responder were 41 .34% ,46 .46% , with corresponding AUC areas of 0 .843 ,0 .796 , sensitivity of 74 .5% ,70 .2% , and specificity of 76 .9% ,80 .8% ,respectively . ROC curve showed the cut‐off value of the length and thickness reduction rate to predict pCR were 57 .36% ,58 .52% ,with corresponding AUC areas of 0 .851 and 0 .895 , sensitivity of 68 .0% ,76 .0% ,and specificity of 94 .6% ,93 .2% ,respectively . Conclusions T he changes of length and thickness of tumor after NCRT are well correlated with treatment response . T he length and thickness reduction rate measured on ERUS present high accuracy in prediction of good response and pCR in LARC patients .

Consensus from international experts for thermal ablation of colorectal liver metastasis / 中国介入影像与治疗学

Liver metastasis is the most common cause of death for patients with colorectal cancer.Surgical resection is the first choice for colorectal cancer liver metastasis (CRLMs),but only 10％-25％ of them are resectable.Patients with unresectable CRLMs are usually treated with systemic chemotherapy and/or local ablative therapies as alternative options.The safety and efficiency of thermal ablation therapies have been improved in recent years.The 5-year survival rate of patients underwent thermal ablation is higher than that of patients underwent chemotherapy for treating CRLMs.A consensus for thermal ablation of colorectal liver metastasis was provided by international experts panel on 2013.The recommendations and indications of thermal ablation for CRLMs were considered and documented according to the literature review based on radiofrequency ablation with long-term follow-up.The main content of the consensus from international experts for thermal ablation of colorectal liver metastasis were reviewed in this article.

Endorectal ultrasound in evaluation on mesorectal fascia invasion in preoperative rectal cancer / 中国医学影像技术

Objective To evaluate the value of endorectal ultrasonography (ERUS) in assessment of mesorectal fascia (MRF) invasion in rectal cancer.Methods Data of 44 patients who accepted preoperative ERUS and total mesorectal excision surgery within a week were retrospective analyzed.There were 18 patients who accepted preoperative neoadjuvant chemotherapy and 26 patients didn't acceped.Taking the pathological diagnosis of circumferential resection margin (CRM) as the gold standard,the diagnostic efficiency of ERUS for the MRF invasion in rectal cancer was evaluated.Results The final pathological T staging was T1 in 2 cases,T2 in 17 cases and T3 in 25 cases.There were 2 cases of CRM positive results,and 42 cases of CRM negative results.With regard to the location of tumor,there were 16 cases located in low,and 28 cases in mid rectum.There were 26 cases located in anterior or antero-lateral wall of rectum,13 cases in posterior or postero-lateral wall,and 5 cases with a circle of rectum.The diagnostic accuracy were 83.33 ％ (15/18) and 92.31％ (24/26) for cases of accepting and not accepting the preoperative neoadjuvant chemotherapy;80.77％ (21/26) for cases located in anterior or antero-lateral wall,and 100％ (13/13) for cases located in posterior or postero-lateral wall;75.00％ (12/16)and 96.43 ％ (27/28) for low position and mid position tumors.The total diagnostic accuracy was 88.64％ (39/44).Conclusion ERUS can be an effective method in preoperative assessment of the MRF invasion in rectal cancer.

Value of endorectalultrasonography in preoperative assessment of rectal cancer post neoadjuvantchemoradiation therapy / 中华医学超声杂志（电子版）

Objective To investigate the value of endorectal ultrasonography (ERUS) inpreoperative assessment of rectal cancer post neoadjuvant chemoradiation therapy.Methods From Jan.2016 to Dec.2016,90 rectal cancer patients who underwent preoperative neoadjuvant chemoradiation therapy and total mesorectal excision surgery in the Sixth Affiliated Hospital of Sun Yat-Sen University were retrospectively analyzed,and all patients underwent ERUS examination post neoadjuvant chemoradiation therapy.Of these,64 patients were evaluated by ERUS pre and post neoadjuvant chemoradiation therapy and 26 patients were evaluated only post neoadjuvant chemoradiation therapy.Wilcoxon rank sum test for paired sample was performed to compare the distance from inferior margin of tumor to anal margin,the length and thickness of the tumor pre and post neoadjuvant chemoradiation therapy respectively in rectal cancer.Taken pathologic findings as golden standard,the accuracy of T staging assessed by ERUS post neoadjuvant chemoradiation therapy was evaluated.Results Compared with pre neoadjuvant chemoradiation therapy,the distance from inferior margin of tumor to anal margin significantly increased after neoadjuvant chemoradiation therapy [(58.63±21.71) mm vs (51.68± 19.81) mm],and the length [(26.10± 10.07) mm vs (40.82±9.18) mm] and thickness [(9.73±2.50) mm vs (14.92±5.30) mm] of tumor also evidently decreased post neoadjuvant chemoradiation therapy,respectively (Z were 4.996,6.153 and 6.076,all P ＜ 0.01).The final pathological T stage was pathologic complete response (pCR) or pT0 in 15 patients,pT1 in 3 patients,pT2 in 30 patients and pT3 in 42 patients.The diagnostic accuracy of T staging of rectal cancer post neoadjuvant chemoradiation therapy for ERUS was uT0 82.2％ (74/90),uT1 96.7％ (87/90),uT2 66.7％ (60/90),uT3 67.8％ (61/90) and uT4 96.7％ (87/90),and the overall accuracy was 82.2％ (74/90).Conclusion ERUS could effectively record the morphological changes of rectal cancer pre and post neoadjuvant chemoradiation therapy,which may contribute to the re-evaluation of the distance from inferior tumor margin to anal margin and the range and depth of tumor involvement pre surgical resection.

The value of ultrasonography in the diagnosis and classifi cation of appendicitis / 中华医学超声杂志（电子版）

ObjectiveTo assess the diagnostic value of ultrasonography in the diagnosis and pathological classifi cation of appendicitis with pathological results.MethodsThe study included 111 cases who confi rmed by surgery and pathology in the Six Affi liated Hospital of Sun Yat-sen University from June2012 to December 2013. The image characteristics of ultrasonic images performed before surgery were analyzed retrospectively. The cases were divided into five groups based on the pathology: 6 acute simple appendicitis, 45 acute suppurative appendicitis, 15 acute gangrenous appendicitis, 33 chronic appendicitis, and 12 acute attack of chronic appendicitis. The length, width and wall thickness of the appendicitis measured by preoperative ultrasound between various pathological type were compared with Kruskal-Wallis statistical methord, and also used the same method to compared the one which had statistically signifi cance between the fi ve groups. As in the above case, Fisher Exact Test was used to compare the characters′ of ultrasonography included gradations of the appendix, the tube cavity expansion, stercorolith, the appendiceal abscess, mergering lymph node enlargement and the appendix around effusion, if there was statistically signifi cance, the same methord was used to the further comparison between thefi ve groups.ResultsTotally 90 of 111 cases of were reminded appendicitis by preoperative ultrasound, the diagnostic accuracy rate was 81.08%, including acute suppurative appendicitis 91.11% (41/45), acute gangrenous appendicitis 93.33% (14/15), acute simple appendicitis 83.33% (5/6), chronic appendicitis 60.61% (20/33), chronic appendicitis onset acute 83.33% (10/12). There were no statistical differences of preoperative ultrasound measured between various pathological type of appendicitis in length, while the appendix width measured by preoperative ultrasound of acute gangrenous appendicitis was wider than the acute simple group and chronic group, and there were statistically signifi cance between them (P<0.05), in the aspect of wall thickness, the acute suppurative appendicitis and the acute gangrenous appendicitis groups were thicker than the chronic group, and these differences had statistically signifi cance (P<0.05). The stercorolith, lymph node enlargement and the appendiceal abscess in different types of appendicitis had no statistical difference. There were statistically differences (P<0.05) between the acute suppurative goup, acute gangrenous group and the chronic group respectively, both in gradations of the appendix and the tube cavity expansion. Also there were statistically difference (P<0.05) between the acute gangrenous appendicitis group and the chronic group in the aspect of the appendix around effusion.ConclusionsUltrasound is valuable in the diagnosis of appendicitis, especially for acute gangrenous appendicitis and acute purulent appendicitis. The measurement of appendix with wide diameter, wall thickness by ultrasond preoperatively, and the characteristics of the wall layers, lumen expansion degree and the appendix around effusion are valuable in identifying chronic appendicitis, acute suppurative appendicitis, and acute gangrene appendicitis; The ultrasonic measurement of appendix wide diameter could identify acute gangrenous appendicitis and acute simple appendicitis. Ultrasound had limited value in identifying acute suppurative, acute gangrenous appendicitis, acute simple appendicitis, chronic appendicitis, and chronic appendicitis onset acute.

AG200 and polysomnography in patients with obstructive sleep apnea-hypopnea syndrome / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the clinical value of polysomnography (PSG) and ApneaGraph (AG200) in the diagnosis evaluation of obstructive sleep apnea hypopnea syndrome (OSAHS).@*METHOD@#From January to December in 2012, 67 OSAHS patients diagnosed by PSG were examined by AG200. The apnea hypopnea index (AHI), hypopnea index (HI), apnea index (AI), the lowest oxygen saturation (LSaO2) was were detected and the results were analyzed statistically.@*RESULT@#Significant differences were observed in AI, AHI, LSaO2 between AG200 and PSG (P 0.05). AHI, HI and LSaO2 was were significantly correlated between AG200 and PSG (r = 0.870, 0.743, 0.374, 0.716, P < 0.01).@*CONCLUSION@#AG200 could not replace PSG but could identify the level of upper airway obstruction.

Value of ultrasonic elastography in diagnosing breast small masses / 中华超声影像学杂志

Objective To investigate the value of ultrasonic elastography(UE) in diagnosing breast small masses (diameter≤10 mm). Methods The static sonograms of conventional ultrasound(US) and UE of the 274 breast small lesions which pathologically proved were reviewed. Images were assigned according to the B1-RADS criteria for US. The elastographic images were evaluated using improved 5-scoring system.Pathology was followed up as diagnostic criteria. The diagnostic performance of the 2 methods was evaluated with receiver operating characteristic curve(ROC). Results The areas under the ROC curve of the two modalities were 0. 891 (UE) and 0.742 (BI-RADS), respectively. The difference between them was significant. Conclusions UE is helpful in differentiating between malignant and benign breast small lesions.

Prospective study of improved elasticity scores in the differential diagnosis of malignant and benign breast lesions / 中华超声影像学杂志

Objective To explore the value of improved elasticity scores in differentiating malignant and benign breast lesions. Methods A prospective study was done in 394 patients with 508 breast lesions confirmed by pathology and the elastographic images of the lesions were evaluated by using old and improved elasticity scores respectively. Results The elastographic images of the lesions could be evaluated and classified in all patients by improved elasticity scores but could not be evaluated and classified in 82 lesions by old elasticity scores. The accuracy of ultrasonic elastography for diagnosing benign and malignant breast lesions was 88.8% and 78.1%, respectively by old elasticity scores and improved elasticity scores. Conclusions The elastographic images of breast lesions were accurately evaluated by using improved elasticity scores, and the use of improved elasticity scores is helpful to reduce the biopsy which is not necessary.

Diagnostic value of strain ratio for differentiation breast benign and malignant solid lesions with ultrasonic elastography / 中华超声影像学杂志

Objective To investigate the diagnostic value of strain ratio for differentiation breast benign and malignant solid lesions. Methods Two hundred and sixty-nine patients with 377 lesions (278 benign, 99 malignant) were included in the study. Ultrasonography found the lesions, then ultrasonic elastography got the strain images. By the strain ratio measure method equipped with the ultrasonic machine, strain ratio of the lesion was calculated. Compared with the pathologic diagnosis, the cut-off point of strain ratio was determined with receiver operating characteristic curve. Results There was significant difference between the strain ratio of benign and malignant lesions( P <0. 05). The cut off point of strain ratio was determined as 3. 08, Youden's index was 0. 88,sensitivity was 97. 38% ,and specificity was 91. 33%. Conclusions Strain ratio could be used to differentiate benign and malignant lesions in breast and would be a new diagnostic standard in future.

Coded harmonic angio:assessment of the therapeutic response in hepatocellular carcinoma treated by transcatheter arterial embolization and radiofrequency ablation / 中华超声影像学杂志

Objective To investigate the value of contrast-enhanced coded harmonic angio (CHA) in evaluating the therapeutic response to combinational treatment of transcatheter arterial embolization (TAE) and radiofrequency ablation (RFA) in hepatocellular carcinoma (HCC). Methods Nineteen patients with 28 HCCs underwent percutaneous RFA in one week after TAE. The therapeutic response was assessed by contrast-enhanced CHA and three-phase dynamic CT in one week before and after the treatment. Results After TAE and RFA, no enhancement was demonstrated in 20 HCCs (71.4%) on contrast-enhanced CHA, which were considered to be completely treated. of the 20 HCCs, no blood signal was identified in 18 on dynamic CT and the conclusion cannot be drawn in the other 2 nodules due to the retention of iodized oil. On contrast-enhanced CHA, enhanced blood signals or tumor stains were identified in the remaining eight HCCs, however, four of the eight could not be evaluated on dynamic CT because of the retention of iodized oil. Conclusions Contrast-enhanced ultrasound can effectively evaluate the treatment response of HCC in combinational therapies of TAE and RFA. It is superior to three-phase dynamic CT for no influence by retention of iodized oil.