Reference values of carotid intima-media thickness and arterial stiffness in Chinese adults based on ultrasound radio frequency signal: A nationwide, multicenter study.

BACKGROUND: Carotid intima-media thickness (IMT) and diameter, stiffness, and wave reflections, are independent and important clinical biomarkers and risk predictors for cardiovascular diseases. The purpose of the present study was to establish nationwide reference values of carotid properties for healthy Chinese adults and to explore potential clinical determinants. METHODS: A total of 3053 healthy Han Chinese adults (1922 women) aged 18-79 years were enrolled at 28 collaborating tertiary centers throughout China between April 2021 and July 2022. The real-time tracking of common carotid artery walls was achieved by the radio frequency (RF) ultrasound system. The IMT, diameter, compliance coefficient, ß stiffness, local pulse wave velocity (PWV), local systolic blood pressure, augmented pressure (AP), and augmentation index (AIx) were then automatically measured and reported. Data were stratified by age groups and sex. The relationships between age and carotid property parameters were analyzed by Jonckheere-Terpstra test and simple linear regressions. The major clinical determinants of carotid properties were identified by Pearson's correlation, multiple linear regression, and analyses of covariance. RESULTS: All the parameters of carotid properties demonstrated significantly age-related trajectories. Women showed thinner IMT, smaller carotid diameter, larger AP, and AIx than men. The ß stiffness and PWV were significantly higher in men than women before forties, but the differences reversed after that. The increase rate of carotid IMT (5.5 µm/year in women and 5.8 µm/year in men) and diameter (0.03 mm/year in both men and women) were similar between men and women. For the stiffness and wave reflections, women showed significantly larger age-related variations than men as demonstrated by steeper regression slopes (all P for age by sex interaction <0.05). The blood pressures, body mass index (BMI), and triglyceride levels were identified as major clinical determinants of carotid properties with adjustment of age and sex. CONCLUSIONS: The age- and sex-specific reference values of carotid properties measured by RF ultrasound for healthy Chinese adults were established. The blood pressures, BMI, and triglyceride levels should be considered for clinical application of corresponding reference values.

Ultrasound-guided thermal ablation for papillary thyroid microcarcinoma: a multicenter retrospective study.

PURPOSE: Ultrasound-guided thermal ablation (including microwave ablation [MWA] and radiofrequency ablation [RFA]) has emerged as a remarkable technology for the treatment of benign and malignant diseases. The objective of this multicenter study was to assess the efficacy and safety of thermal ablation in a large cohort of patients with papillary thyroid microcarcinoma (PTMC). MATERIALS AND METHODS: Retrospective study of 725 patients who underwent MWA/RFA at 11 centers between March 2015 and March 2020. The mean age of patients was 46 ± 11 years (range, 22-81); the mean follow-up time was 21 ± 13 months (range, 6-60). Changes in size of tumor, the rates of tumor disappearance, disease progression, and complications were assessed. RESULTS: From 6 months post-ablation, the size of tumors was significantly reduced compared with those recorded pre-ablation (p < 0.001 for all). Five hundred and fifteen (71.0%) PTMCs had completely disappeared as assessed by ultrasound examination. Six (0.8%) patients developed disease progression post-ablation; of these, 5 (0.7%) patients developed new PTMCs, while one (0.1%) patient developed cervical lymph node metastasis. Nineteen (2.6%) patients developed complications post-ablation; of these 14 (1.9%) patients developed voice hoarseness, 4 (0.6%) developed hematoma, and one (0.1%) patient developed cough. CONCLUSIONS: Ultrasound-guided thermal ablation represents an effective and safe treatment for patients with PTMC besides active surveillance and surgery.

Efficacy and Safety of Thermal Ablation for Treatment of Solitary T1N0M0 Papillary Thyroid Carcinoma: A Multicenter Retrospective Study.

Background Microwave ablation (MWA) and radiofrequency ablation (RFA) have recently attracted interest as minimally invasive treatment modalities for papillary thyroid carcinoma (PTC). However, the ablation outcomes of T1N0M0 PTC are not well characterized. Purpose To evaluate the efficacy and safety of thermal ablation (MWA or RFA) of solitary T1N0M0 PTC in patients who were ineligible for (due to presence of comorbid cardiovascular disease, renal failure, other malignancy, etc) or who refused surgery. Materials and Methods This was a retrospective multicenter study of 847 patients (660 women) who underwent thermal ablation for PTC (673 T1a, 174 T1b) between March 2015 and March 2020; of these patients, 645 underwent MWA and 202 underwent RFA. The mean age of patients was 46 years ± 11 (standard deviation) (age range, 18-81 years); the mean follow-up time was 22 months ± 13 (range, 6-60 months). Changes in tumor size and volume and the rates of technical success, tumor disappearance, disease progression, and complications were assessed. Results The technical success rate was 100%. Relative to preablation measurements, the maximum diameter and volume of the ablation zone increased during the 1st month after ablation (P < .001), whereas there was no difference by the 3rd month; subsequently, the tumors showed reduction in size at 6, 9, and 12 months (all P < .001). Complete disappearance of tumors occurred in 68% of patients (577 of 847; 69% [466 of 673] in the T1a group vs 64% [111 of 174] in the T1b group; P < .001). The postablation disease progression rate was 1.1% (nine of 847 patients; 0.9% [six of 673 patients] in the T1a group vs 1.7% [three of 174 patients] in the T1b group; P = .54). The overall complication rate was 3.4% (29 of 847 patients; 2.7% [18 of 673 patients] in the T1a group vs 6.3% [11 of 174 patients] in the T1b group; P = .02). Conclusion This multicenter study provided evidence that thermal ablation is an effective and safe treatment option in selected -patients with solitary T1N0M0 papillary thyroid carcinoma. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Baek and Cho in this issue.

Efficacy and Safety of Thermal Ablation for Solitary T1bN0M0 Papillary Thyroid Carcinoma: A Multicenter Study.

BACKGROUND: Ultrasound-guided thermal ablation plays an important role in the management of thyroid disease. The objective of this study was to evaluate the feasibility, efficacy, and safety of thermal ablation for patients with solitary T1bN0M0 papillary thyroid carcinoma (PTC) who are ineligible for or unwilling to undergo surgery. MATERIALS AND METHODS: Data pertaining to 172 patients (38 males and 134 females) who received thermal ablation therapy at 12 hospitals between April 2015 and March 2020 were retrospectively analyzed. The mean duration of follow-up was 24.9 ±â€…14.1 months (range, 12-60). The technical feasibility, technical success, efficacy, and safety of treatment were analyzed. Postablation tumor size at various time points was compared with preablation measurement. RESULTS: All patients selected for thermal ablation received enlarged ablation, according to contrast-enhanced ultrasound postablation. The maximum diameter and volume of ablation zone at 6, 12, 18, 24, 36, and 48 months postablation were significantly smaller than those recorded preablation (P < 0.05 for all). At the most recent follow-up, 106 (61.6%) tumors had completely disappeared. The rate of lymph node metastasis was 0.6% (1/172) and the incidence of new tumors was 1.2% (2/172). The overall complication rate was 5.2% (9/172) (major complications: 4.6% [8/172]; minor complications: 0.6% [1/172]). All major complications were relieved within 4 months postablation. CONCLUSION: Thermal ablation may be a feasible, effective, and safe treatment option for patients with solitary T1bN0M0 PTC who are ineligible for or unwilling to undergo surgery. It may provide a novel treatment option for selected patients.

Inhibition of hyperplasia during the implantation of the puborectalis-like artificial anal sphincter.

OBJECTIVES: This study aims to extend the implantation lifetime of the puborectalis-like artificial anal sphincter by inhibiting the occurrence of hyperplasia following the implantation process. METHOD: A new transmission structure was designed inside the puborectalis-like artificial anal sphincter to generate an adequate torque to maintain the feces, even if hyperplasia developed around the prosthetic sphincter. An outer shell was added to the prosthetic sphincter to decelerate the occurrence of hyperplasia on the outer shell side. Medical titanium alloy was tested to replace the nylon-12 prosthetic sphincter, while polyetheretherketone was used for the construction of the power supply unit in the puborectalis-like artificial anal sphincter system instead of nylon-12. In vivo experiments were conducted to evaluate all the methods presented in this study with 10 Pa Ma piglets, 1 domestic pig, and 1 beagle dog during the past 2 years. RESULTS: Compared with the previous prosthetic sphincter that was equipped with a fixed-axle gear transmission, the new transmission structure is equipped with a planet-gear train managed to generate a prosthetic sphincter output with a 53% larger torque but with the same size and type of motor as that used previously and increase the implantation lifetime by 56%. After the replacement of the nylon-12, the new prosthetic sphincter made of medical titanium alloy succeeded in extending the implanted lifetime by 83%. In addition, the lifetime was increased by 143%, when an outer shell was added to the prosthetic sphincter. Polyetheretherketone significantly decreased the growth rate of hyperplasia around the power supply unit by 44% after the replacement of the power supply unit material. After the combination of all the improvements, the longest implantation lifetime of the puborectalis-like artificial anal sphincter during the in vivo experiments was 7 months and 10 days, which reflected an improvement of 249%. CONCLUSION: All methods posted in this study were evaluated to be effective to prolong the implantation lifetime of the puborectalis-like artificial anal sphincter. Among the methods proposed, the most effective was the addition of the outer shell to the puborectalis-like artificial anal sphincter. The least effective method was the improvement of the transmission structure. Medical titanium alloy and polyetheretherketone were good replacements for nylon-12 that managed to extend the implantation lifetime and yield a moderate improvement.

Mechanical characteristics of the pulmonary artery in beagle dogs with hepatopulmonary syndrome and portopulmonary hypertension.

The continuous changes in pulmonary hemodynamic properties in hepatopulmonary syndrome (HPS) and portopulmonary hypertension (PoPH) have not been fully characterized in large animal models of HPS and PoPH. Beagle dog models of HPS and PoPH were induced by chronic common bile duct ligation and Sephadex microspheres, respectively. The model was validated by catheter examination and pathological analyses, and the hemodynamic characteristics of the models were observed. The results revealed that the cross-sectional area of the blood vessel was significantly increased in HPS models, but it was significantly decreased in the PoPH models. Furthermore, the resistance of pulmonary circulation was elevated in models of HPS, but it was decreased in models of PoPH. The present findings renew the traditional view that pulmonary hypertension is due to the enhanced peripheral resistance.

Research on Ovary Blood Flow Before and After Uterine Artery Embolization with the Application of Color Doppler Blood Imaging.

OBJECTIVE: To analyze the influence of uterine artery embolization (UAE) in the hemodynamics level with the application of color Doppler blood flow imaging. STUDY DESIGN: Patients (N = 32) with benign gynecologic diseases amenable to UAE were selected. Using color Doppler flow imaging, we measured the ovarian and uterine artery systolic blood flow velocity peak and end diastolic blood flow velocity and resistance index 1 day before UAE and 1 week, 1 month, and 3 months after UAE. RESULTS: The success rate of UAE in the 32 patients was 100%. After UAE, clinical symptoms in all patients were improved. Measurements of the uterine artery peak systolic flow velocity, end diastolic blood flow velocity, and resistance index before and after UAE revealed statistically significant differences between the indexes (p < 0.05). CONCLUSION: UAE in benign gynecologic diseases is simple, less invasive, and allows for a shorter hospital stay. Color Doppler flow imaging can be used as a novel method before and after UAE to evaluate the clinical effect of UAE in benign gynecologic diseases.

Artificial neural network aided non-invasive grading evaluation of hepatic fibrosis by duplex ultrasonography.

BACKGROUND: Artificial neural networks (ANNs) are widely studied for evaluating diseases. This paper discusses the intelligence mode of an ANN in grading the diagnosis of liver fibrosis by duplex ultrasonogaphy. METHODS: 239 patients who were confirmed as having liver fibrosis or cirrhosis by ultrasound guided liver biopsy were investigated in this study. We quantified ultrasonographic parameters as significant parameters using a data optimization procedure applied to an ANN. 179 patients were typed at random as the training group; 60 additional patients were consequently enrolled as the validating group. Performance of the ANN was evaluated according to accuracy, sensitivity, specificity, Youden's index and receiver operating characteristic (ROC) analysis. RESULTS: 5 ultrasonographic parameters; i.e., the liver parenchyma, thickness of spleen, hepatic vein (HV) waveform, hepatic artery pulsatile index (HAPI) and HV damping index (HVDI), were enrolled as the input neurons in the ANN model. The sensitivity, specificity and accuracy of the ANN model for quantitative diagnosis of liver fibrosis were 95.0%, 85.0% and 88.3%, respectively. The Youden's index (YI) was 0.80. CONCLUSIONS: The established ANN model had good sensitivity and specificity in quantitative diagnosis of hepatic fibrosis or liver cirrhosis. Our study suggests that the ANN model based on duplex ultrasound may help non-invasive grading diagnosis of liver fibrosis in clinical practice.

Individualized treatment models based on blood supply characteristics in hepatocellular carcinoma using color Doppler hemodynamics.

BACKGROUND/AIMS: We evaluated the long-term efficacy of the combination of transcatheter arterial chemoembolization (TACE) using cisplatin-lipiodol suspension, transultrasonic portal vein chemoembolization (SPVE), radiofrequency ablation (RF), percutaneous ethanol injection (PEI) for treatment of advanced small hepatocellular carcinoma (HCC). METHODOLOGY: A total of three hundred and eighteen patients with HCC were enrolled in this study. According to the blood supply characteristics to the tumor, individual combined therapy models were adopted: one hundred and fifty-nine patients with HCC less than 5 cm were treated with a combination of RF and PEI (RF/PEI group) and one hundred and one patients with HCC greater than 5cm were treated with a combination of TACE, RF and PEI (TACE/RF/PEI group). One hundred and eleven HCC nodules confirmed to be hypervascular by color Doppler flow imaging were treated with a combination of TACE, RF, SPVE and PEI (TACE/ RF/SPVE/PEI group). RESULTS: The combination treatment of RF and PEI (RF/PEI group), the TACE/RF/PEI group, TACE/ RF/SPVE/PEI group, the 1-year survival rates and the 3-year survival rates were 97.3% and 82.4%; 73.5% and 44.9%; 74.1% and 37.9%, respectively; The vanishing rate of blood flow around and within the tumor, the tumor size decrease rate, AFP transformed to negative rate, were significantly raised compared to those in the TACE treatment only group. CONCLUSIONS: The individual combined therapy models combination of TACE, PEI, SPVE, RF appears to prolong survival, compared with one treatment alone (TACE). This combination therapy method is an effective way for treating HCC, and color Doppler can provide important information to verify the therapeutic effects.

Experimental study on the relation between the noninvasive ultrasonography quantitative scoring system and the degree of the hepatic fibrosis.

BACKGROUND/AIMS: The fibrosis models were constructed in the experimental rats which underwent complex fibrosis models methods, and the aim was to assess the value of noninvasive ultrasonography quantitative scoring system in the diagnosis of hepatic fibrosis using high-frequency ultrasonography unit. METHODOLOGY: Thirty-five male rats were included in this study. The fibrosis models were constructed in the 35 experimental rats which underwent complex fibrosis models methods. Ultrasonography, serum fibrosis markers were submitted in week 0, week 2, week 4, and week 6, during the construction of fibrosis models, which were also detected with pathological diagnosis. Ultrasonography quantitative scoring system was used to discriminate the degree of hepatic fibrosis, and the results were compared with pathological diagnosis. RESULTS: The complex fibrosis models methods can be used to construct hepatic fibrosis model. The ultrasonography quantitative scoring system had a higher relativity to pathological stage (r=0.86), when it was combined with serum fibrosis markers, the sensitivity (96.5%) and specificity (95.8%) were increased. CONCLUSIONS: High-frequency ultrasonography appears to be an efficient tool allowing new possibilities to use this animal model, ultrasonography quantitative scoring system, especially when it was combined with CT, serum fibrosis markers, had a higher value in noninvasive quantitative diagnosis of hepatic fibrosis in longitudinal studies, which are much more powerful.

A study on the relationship between ultrasonographic score and clinical score (MELD, CPT) in cirrhosis.

BACKGROUND/AIMS: This article aimed to compare ultrasonography score with CTP score and MELD score, as well as, describe the possibility of a noninvasive diagnosis of the degree of hepatic fibrosis using the various imaging techniques and provide suggestions for daily clinical practice. METHODOLOGY: A total of 53 patients (33 male and 20 female) admitted to our Hospital between March 2004 and March 2005, were included in this preliminary study. Twenty-five age-matched healthy persons (17 male, 8 female) served as controls. The ultrasound quantitative scoring system was applied in this test which was established according to the previous researcher. All the patients and control group underwent ultrasonography and CT examination. CTP and MELD score were calculated using standard formula. RESULTS: The ultrasound quantitative scoring system, as well as CTP, and MELD score had a higher relativity to pathological stage. Correlations between ultrasonography score, CTP, and MELD score were assessed by the Spearman correlation coefficient. Correlation coefficient was 0.784, and 0.768 respectively. CONCLUSIONS: Ultrasound can be recommended as one of the choices for noninvasive diagnosis of hepatic fibrosis for its advantages. Increasing CTP (less than 10) and MELD score correlated with progressive impairment of liver function as evaluated by means of a blood flow-dependent quantitative liver function test.