Clinical Practice Report of Contrast-Enhanced Ultrasound in Renal Artery Disease.

OBJECTIVES: To evaluate the diagnostic performance of renal artery contrast-enhanced ultrasound (CEUS) with modified inspection section and summarize subsequent changes in imaging assessment of renal artery disease. METHODS: A total of 1015 patients underwent renal artery CEUS were included in the study. Among them, 79 patients (156 renal arteries) suspected with renal artery stenosis (RAS) underwent digital subtraction angiography (DSA) subsequently. DSA was used as the gold standard to evaluate the diagnostic performance of CEUS in detecting RAS (≥30%) and severe stenosis (≥70%), as well as the diagnostic accuracy of classification of stenosis degree. Besides, 127 of the 1015 patients underwent other imaging examinations such as computed tomography angiography (CTA) or magnetic resonance angiography (MRA) after CEUS and annual proportion of these imaging examinations was assessed. RESULTS: The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of CEUS for detecting RAS (≥30%) was 96.4%, 88.6%, 94.2%, 95.6% and 90.7%, respectively and the kappa value was .857 (P < .01). CEUS had a good performance in distinguishing severe stenosis (≥70%) with a sensitivity of 91.1%, specificity of 95.5%, accuracy of 92.9%, PPV of 96.5%, NPV of 88.7% and the kappa value was 0.857(P < .01). There was no significant difference between CEUS and DSA in detecting stenosis (P = 1.0) and severe stenosis (P = .227). The diagnostic accuracy of CEUS in grading RAS was 85.3% and the kappa value was 0.753 (P < .01). Besides, the annual proportion of other imaging examinations decreased for 4 consecutive years. CONCLUSIONS: CEUS is a non-invasive, safe and valuable technique for the assessment of renal artery disease and worthy of promotion.

Renal elasticity and perfusion changes on ultrasonography in an early-stage diabetic rat model.

Background: Renal hemodynamic changes in early diabetes occur before the onset of significant structural abnormalities or clinical manifestations, and timely detection of these changes has clinical significance. This study aimed to evaluate renal elasticity and perfusion changes in an early-stage diabetic rat model by shear wave elastography (SWE) and contrast-enhanced ultrasound (CEUS), and to explore the potential correlations between renal elasticity and perfusion parameters. Methods: A total of 18 male Sprague-Dawley rats were randomly divided into three groups: a control group (group 1, n=6), a diabetic group (group 2, n=6), and a diabetic group receiving drug therapy (group 3, n=6). An intraperitoneal injection of streptozotocin (STZ) for 2 days combined with a high-fat diet (HFD) was used as the early-stage diabetic rat model. The diabetic rats in group 3 were treated with canagliflozin and losartan for 6 weeks, whereas the rats in groups 1 and 2 were given equal amounts of purified water. Renal stiffness on SWE and perfusion parameters on CEUS were measured and compared among the three groups, then the rats were sacrificed, and serum, urine, and renal histopathology were evaluated to confirm the development of early diabetes. Results: The early-stage diabetic rats without significant pathological changes exhibited bigger kidneys and higher blood glucose (all P<0.05). Among the CEUS parameters, peak enhancement (PE), wash-in area under the curve (WiAUC), wash-in perfusion index (WiPI), wash-out AUC (WoAUC), wash-in and wash-out AUC (WiWoAUC), rise time (RT), and time to peak (TTP) of diabetic rats in group 2 were significantly increased (all P<0.05), and the hyperperfusion ameliorated significantly after drug treatment. The renal elasticity measured by SWE varied in accordance with certain perfusion parameters, and was strongly positively correlated with WiAUC (r=0.701, P<0.001), WoAUC (r=0.647, P<0.001), and WiWoAUC (r=0.655, P<0.001), and moderately positively correlated with PE (r=0.539, P=0.001), WiPI (r=0.555, P<0.001), RT (r=0.425, P=0.010), and TTP (r=0.439, P=0.007). Conclusions: Renal elasticity and perfusion changes in the early stage of diabetes, and renal elasticity was positively associated with delayed and increased perfusion.

Prognostic Value of Coronary Artery Calcification Identified by the Semi-quantitative Weston Method in the Emergency Room or Other Hospitalized Patients.

Background: Coronary artery calcification (CAC) may provide insight to the patients' coronary artery disease (CAD) risks and influence early intervention. With increasing use of non-gated CT scans in clinical practice, the visual coronary artery scoring system (Weston Method) could quickly provide clinicians with important information of CAC for patient triage and management. Methods: We retrospectively studied the available CT imaging data and estimated CAC burden using the Weston method in 493 emergency room or other hospitalized patients. The Weston scores were calculated by the sum of the score for each vessel including the left main, left anterior descending, left circumflex artery and right coronary artery (range 0-12). The primary endpoint was a composite of the major adverse cardiac events (MACEs), including cardiac death, myocardial infarction, stroke, and coronary revascularization. Results: During a median follow-up of 85 months, a total of 25 (5.1%) MACE were recorded and 57 (11.2%) patients died from any causes. Detectable CAC was most common (96%) in the left anterior descending coronary arteries. Multivariable analysis showed that CAC total scores were independent predictors for MACE and all-cause mortality. Receiver operating characteristic analysis showed that CAC total score ≥5 was the optimal cutoff value for predicting MACEs. Conclusions: In the emergency room and hospitalized patients, the semi-quantitation of CAC burden using the Weston score system was related to the long-term cardiovascular outcomes including mortality. Clinicians and radiologists should maximize the value of non-contrast chest CT images by reporting CAC details.

Severely Impaired Renal Function in Unilateral Atherosclerotic Renal Artery Stenosis Indicated by Renal Slow Perfusion.

PURPOSE: Renal artery stenosis leads to ischemic renal insufficiency, but methods for assessing renal perfusion are limited. This study aimed to evaluate the association between renal slow perfusion and impaired renal function in atherosclerotic renal artery stenosis (ARAS). PATIENTS AND METHODS: A total of 79 consecutive patients with uncontrolled hypertension who underwent renal angiography and renal dynamic scintigraphy for suspected ARAS were enrolled in the retrospective descriptive study. Based on the status of renal artery stenosis and renal perfusion, participants were divided into three groups: the control group (n=26), the unilateral ARAS with renal normal perfusion group (RNP, n=30), and the unilateral ARAS with renal slow perfusion group (RSP, n=23). RSP was defined as renal blush grade (RBG) ≤1, while RBG>1 belonged to RNP. Split renal function (SRF) was achieved from 99mTc-DTPA renal scintigraphy. The value of the difference in split renal function (DSRF) is contralateral SRF minus impaired SRF of paired kidneys in ARAS. We compared the SRF and DSRF between different groups to identify the association between renal slow perfusion and renal impairment in ARAS. RESULTS: We analyzed SRF for paired kidneys and found the following: (1) The SRF of the paired kidney was similar in the RNP group (24.3 ± 10.2 mL/min vs 27.5 ± 8.4 mL/min; P = 0.19); however, the impaired SRF was obviously decreased compared with the contralateral SRF in the RSP group (13.5 ± 8.6 mL/min vs 36.7 ± 16.9 mL/min; P < 0.001); and (2) The difference in SRF in the RSP group was significantly higher than that in the control and RNP groups (19.8 ± 11.9 mL/min vs 4.8 ± 8.1 mL/min; 19.8 ± 11.9 mL/min vs 4.6±3.7 mL/min; P < 0.05). CONCLUSION: As an angiographic phenomenon, renal slow perfusion might be an indicator of severely impaired renal function.

Rationale and study design for one-stop assessment of renal artery stenosis and renal microvascular perfusion with contrast-enhanced ultrasound for patients with suspected renovascular hypertension.

BACKGROUND: Renal artery stenosis (RAS) is always associated with abnormalities in renal microvascular perfusion (RMP). However, few imaging methods can simultaneously evaluate the degree of luminal stenosis and RMP. Thus, this study will aim to evaluate the feasibility of using contrast-enhanced ultrasound (CEUS) for assessing both RAS and RMP to achieve a one-stop assessment of patients with suspected renovascular hypertension. METHODS: This will be a single-center diagnostic study with a sample size of 440. Patients with chronic kidney disease (CKD) and suspected of having resistant hypertension will be eligible. Patients with Stages 1-3 CKD will undergo CEUS and computed tomography (CT) angiography (CTA). Values obtained by CEUS and CTA for diagnosing low-grade (lumen reduced by <60%) and high-grade (lumen reduced by ≥60%) RAS will be compared. Moreover, all patients will also undergo radionuclide imaging. The diagnostic value for RAS will be assessed by the receiver operating characteristic curve, including the accuracy, sensitivity, specificity, positive predictive values, negative predictive values, and area under the ROC. Pearson correlation analysis will be performed to assess the association between CEUS findings for RMP and glomerular filtration rate measured by a radionuclide imaging method. CONCLUSION: The data gathered from this study will be used to evaluate the feasibility of expanding clinical applications of CEUS for evaluation of patients with suspected renovascular hypertension. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR1800016252; https://www.chictr.org.cn.

[The study in detection of microcalcification in early breast cancer by ultrasound and its correlation with pathohistology].

OBJECTIVE: To discuss the role of ultrasound in examining microcalcification of early breast cancer and its correlation with pathohistological type and grade. METHODS: 178 lesions in 165 cases of early breast cancer confirmed by pathology after surgical resection were examine by high frequency ultrasound, meanwhile microcalcification were detected and reported. 39 lesions in 32 cases are carcinoma in situ and microinvasive carcinoma of breast. 139 lesions in 133 cases are early invasive breast carcinoma that is below 2 cm in diameter and doesn't invasive the lymph node and other parts of the body. To analyse the sensitivity of detection micro-calcification of early breast cancer by ultrasound and its correlation with pathohistological type and grade. RESULTS: The sensitivity is 81.6% in detecting microcalcification of early breast cancer by ultrasound. There is no significant statistical difference in detecting microcalcification between the two group (P = 0.217). There is no significant statistical difference in detecting microcalcification of early invasive breast cancer between the different pathologic types (P > 0.05), and there are no significant differences in detecting microcalcification of early breast cancer between the different pathologic grades (group I: P = 0.202, group II: P = 0.415). There is significant difference in detecting microcalcification of solid tumor by ultrasonic examination in group I between the different pathologic grades (P = 0.029). CONCLUSION: There is higher sensitivity in detecting microcalcification of early breast cancer by ultrasonography. Microcalcification of early breast cancer may be no closely related to pathologic grades. US has a certain value to clinic in detecting microcalcification of early breast cancer.

Study of endorectal ultrasonography in the staging of rectal cancer.

BACKGROUND: There is no consensus regarding the performance for endorectal ultrasonography (ERUS) at every stage of rectal cancer. Thus, the purpose of our study was to further assess the value of ERUS in the preoperative staging of rectal cancer. METHODS: A retrospective study was performed with 44 consecutive patients (mean age: (63.3 ± 10.2) years) who underwent surgical treatment for endorectal carcinoma and were preoperatively evaluated using Biplane ERUS between September 2008 and December 2010. We compared the ERUS staging with the pathological findings based on surgical specimens. RESULTS: ERUS staging agreed with the histologic staging in 39 of the 44 (88.6%) patients: the agreement on the depth of transmural invasion was good (κ = 0.73; 95%CI: 0.60 - 0.86, P = 0.000). The detection sensitivities of rectal cancer with ERUS were as follows: T1 85.7%, T2 87.5%, T3 88.9%, and T4 100.0% with specificity values of T1 97.3%, T2 92.9%, T3 96.2%, and T4 97.6%. ERUS correctly staged patients with T1 95.5%, T2 90.9%, T3 70.5%, and T4 97.7%. The positive predictive value of ERUS was lowest for T4 (75%), but highest for T3 (94.1%) followed by T2 (87.5%) and T1 (85.7%); the negative predictive values of ERUS from high to low were ordered as T4 (100%), T1 (97.3%), T2 (92.9%), and T3 (92.6%). The percentage of total over-staged cases was 4.5% and the under-staged cases was 6.8%. The extent of perirectal lymph node metastases was determined with a sensitivity of 68.4% (13/19), specificity of 80.0% (20/25), and diagnostic accuracy of 75.0% (33/44). CONCLUSION: Biplane ERUS has a high diagnostic accuracy for tumoral invasion of the rectal wall at every T stage, but relatively low diagnostic accuracy for lymph node metastases.

[Assessment of synovitis in the knee of patients with newly-diagnosed rheumatoid arthritis using high frequency and color Doppler ultrasonography].

OBJECTIVE: To investigate the value of high frequency and color Doppler ultrasonography in detection of synovitis and the intra-articular vascularization in the knee joint of patients with newly-diagnosed rheumatoid arthritis (RA). METHODS: Forty-one patients (30 women, 11 men) with newly-diagnosed RA were recruited to a cross sectional study (RA group). Forty-one age and gender-matched healthy volunteers were used as control group. The thickness of hydatid fluid, synovium hyperplasia, color flow imaging, peak systolic velocity (PSV), end diastolic velocity (EDV), resistance index (RI), venous blood flow and intra-articular perfusion were evaluated by high frequency and color Doppler ultrasonography. RESULTS: Totally 91.46% knee joints with synovial hyperplasia (> 2 mm) were found in 41 patients with RA (75/82 knee joints), and the thickness of the synovial membrane was 2.2 - 19.7 mm (average 6.3 ± 3.4 mm). In aspect of blood flow, the percentage of 0 to 3 grade were 18.67% (14/75), 29.33% (22/75), 45.33% (34/75) and 6.67% (5/75), respectively; the results of arterial blood were indicated with PSV (10.82 ± 3.71 cm/s), EDV (3.86 ± 1.12 cm/s) and RI (0.61 ± 0.07), while the average of venous blood velocity was 2.72 ± 1.02 cm/s. Joint effusion was found in 69 joints (84.15%) with the anteroposterior diameter 2.4 - 16.1 mm (average 6.9 ± 3.2 mm). The thickness of synovial membrane was 1.2 - 1.8 mm (average 1.4 ± 0.4 mm) and no significant difference were observed in joint effusion, signal of blood flow and thickness of synovial membrane in the control group. CONCLUSIONS: High frequency and power Doppler ultrasonography may be a valuable and optimal clinical tool to accurately and objectively detect synovial hyperplasia, vascular pannus formation and joint effusion in the knee joint of patients with RA.

[Application of ROC curve for the evaluation of arterial stiffness and heart function in hypertensive patients by quantitative artery stiffness].

OBJECTIVE: To apply the receiver operating characteristic (ROC) curves and QAS technology in exploring sensitive and feasible indices about the structure and function of heart and arterial stiffness so as to determine the optimal operating point (OOP) and evaluate its value of cardiovascular changes in hypertensive patients. METHODS: The parameters of arterial stiffness and heart function were measured and calculated in hypertensive patients (n = 167) and control (n = 165). The results were compared and critical values obtained by receiver operating characteristic (ROC) curves. RESULTS: Interventricular septal thickness, posterior wall thickness of left ventricle, E/e and Tei of hypertensive group were significantly higher than those of control group (P < 0.05). In hypertensive group, the parameters of arterial stiffness including beta, and PWVbeta were significantly higher than those of control group (P < 0.05). The areas of under the ROC curves were 0.808, 0.843, 0.816, 0.827, 0.779 and 0.632. The sensitivity and specificity of detecting the cardiovascular changes of hypertension for interventricular septal thickness, posterior wall thickness of left ventricle, E/e, Tei, PWVbeta and beta were 78.6%/78.9%, 82.1%/84.2%, 67.9%/89.5%, 100%/52.6%, 82.1%/68.4% and 57.1%/63.2% respectively. CONCLUSION: The arterial stiffness and heart dysfunction may result from hypertension. Arterial stiffness can be one of monitoring indices in early-stage damage of heart function.

[Monitoring of ultrasonography in artificial vascular graft for arteriovenous fistula].

OBJECTIVE: To evaluate the monitoring of ultrasonography in artificial vascular graft for arteriovenous fistula and its complications in patients with chronic renal failure. METHODS: Eighteen cases of artificial vascular graft arteriovenous fistula after four to six weeks were enrolled. The diameter, the peak velocity and blood flow were examined in arterial fistula. And the artificial vascular diameter, the peak velocity and blood flow of artificial vessels next to artery were all examined and analyzed. And the patients with symptoms in the upper extremity were tested by ultrasound. RESULTS: Intravascular blood showed good filling in fistula and artificial blood vessels in four to six weeks after artificial vascular graft for arteriovenous fistula by color doppler ultrasonography. The arterial fistula diameter, the peak velocity and blood flow were (3.61 +/- 0.68) mm and (298.56 +/- 93.42) cm/s and (583.62 +/- 216.77) ml/min. Artificial vascular diameter in (4.47 +/- 0.61) mm, the peak velocity and blood flow were (219.37 +/- 68.42) cm/s and (325.23 +/- 117.12) ml/min in the artificial blood vessels next to artery. Seven patients with upper extremity discomfort were examined by ultrasonography. One case was serum swollen. Three cases were thrombosis in artificial vessels. One case was pseudoaneurysm. Two cases were edema. CONCLUSIONS: Ultrasonography plays a significant clinic role in testing artificial vascular graft for arteriovenous fistula and its complications.