Metabolic dysfunction-associated steatotic liver disease（MASLD）has become one of the leading causes of chronic liver diseases in China and even globally. Early non-invasive diagnosis and grading MASLD，along with timely intervention，are crucial for assessing the disease condition and slowing the disease progression. In recent years，non-invasive techniques for assessing liver steatosis content based on ultrasound have attracted significant attention. The ultrasound derived fat fraction（UDFF）is an emerging quantitative technique for liver fat assessment using ultrasound，which calculates the percentage value of the fat content by analyzing the radiofrequency signals reflected from the liver tissue，thereby quantifying the degree of liver steatosis. UDFF shows significant potential in assessing liver steatosis. However，the current application guidelines based on this technology do not yet fully meet the clinical needs. To further standardize its clinical application，institutions such as the Ultrasound Medicine Branch of the Chinese Medical Association，the National Clinical Research Center for Aging and Medicine，and the Institute of Ultrasound Medicine and Engineering of Fudan University，together with multidisciplinary experts ultrasound，endocrinology，radiology，and hepatology from across China have formulated this "Chinese expert consensus on the use of ultrasound derived fat fraction in the assessment of metabolic dysfunction-associated steatotic liver disease（2025 edition）" based on the lastest clinical application advances of the UDFF technology. This consensus standardizes the clinical scope of application and scenarios of this technology. It optimizes the technical operation process in various aspects，including pre- examination preparation，the operation process，quality control，the number of measurements，result presentation format，and influencing factors as well. Meanwhile，it summarizes current clinical research results，aiming to ensure the standardization of the UDFF technology in clinical applications.
Ultrasound-guided percutaneous lung needle biopsy(US-PLNB)is a pivotal diagnostic technique for subpleural pulmonary lesions,offering significant advantages such as real-time imaging,absence of ionizing radiation,and high operational flexibility.To standardize its clinical application and enhance both procedural safety and diagnostic accuracy,a multidisciplinary panel of experts was convened by eleven authoritative Chinese academic societies,including Chinese Society of Ultrasound in Medicine.Based on the latest domestic and international evidence-based medicine,this panel developed Chinese expert consensus on ultrasound-guided percutaneous lung needle biopsy(2025 edition).This consensus systematically elaborates on the indications and contraindications,preprocedural assessment and preparation,intraoperative techniques,complication prevention and management,and post-procedural care for US-PLNB.Furthermore,it puts forward 18 specific evidence-based recommendations.The primary aim of this consensus is to provide radiologists and clinicians with standardized operational guidance,promote the standardized application of US-PLNB,and ultimately improve patient care for individuals with pulmonary diseases.
PURPOSE:To evaluate the proposed explainable denoising deep learning model, Grouped Shared Convolutional Attention Vision Transformer (GSCAViT), for classifying normal fetal echocardiogram. METHODS:A retrospective study was conducted on 358 fetal cardiac ultrasound exams with a total of 2501 images. GSCAViT utilized seven echocardiograms and was compared against baseline and enhanced models using metrics including accuracy, precision, recall, F1 score. The SHAP method clarified key image features, and the denoising guided GSCA module was assessed through visual comparisons and image quality metrics. RESULTS:GSCAViT achieved an accuracy of 97.1%, 99.4%, 81.3%, 72.9% on the validation and three test sets. In addition, GSCAViT achieved low error rates of 2.9%, 0.6%, 18.7%, and 27.1%. To improve upon existing Vision Transformer based models and denoising modules, we propose the GSCAViT, which integrates a novel denoising-guided GSCA module for enhanced image quality and interpretability. SHAP visualizations confirmed the model's ability to identify critical cardiac structures, while the denoising module enhanced image quality, yielding the highest contrast-to-noise ratio and peak signal-to-noise ratio values. CONCLUSION:GSCAViT outperformed baseline and several enhanced models in classifying seven types of normal fetal echocardiograms, SHAP visualization enhanced the interpretability of classification, comparisons of visual effectiveness and image parameters confirmed the efficacy of the GSCA module.
患者女，30岁，因腰背酸胀2个月余，右手背尺侧麻木2 d入院，专科查体示：四肢肢体肌张力正常，双侧躯体感觉正常，四肢腱反射消失，双侧病理征阴性。入院后行右侧尺神经超声检查提示：右侧尺神经全程肿胀增粗，以近心段明显，最粗处位于右上臂中段，该水平前后9.8 mm，左右径23.8 mm，最大截面积178 mm 2(描记该水平神经周长测量)，神经连续，神经外膜回声增高，内部神经束增粗但保留基本正常的神经束丛样结构，部分神经束膜回声减低，模糊；神经干内见少许血流信号。上述常规临床申请检查结束后超声医师怀疑右侧尺神经不是单发病变，后续又扫查对侧尺神经、双侧桡神经、双侧正中神经、双侧臂丛神经、双侧胫神经、双侧腓总神经及双侧坐骨神经，发现除腓总神经、坐骨神经未见明显异常外，其他周围神经双侧均存在不同程度的弥漫增粗样改变(图1)。MRI显示马尾及双侧骶丛神经弥漫增粗，双侧臂丛神经纤维束明显增粗、部分呈结节样增粗。肌电图检查提示上、下肢多发周围神经损害，髓鞘伴轴索，下肢较重。右侧腓肠神经病理电镜提示有髓神经纤维密度显著减低伴脱髓鞘，伴随"洋葱球样"结构形成，呈慢性混合性病理改变；病变均匀，且未见炎细胞浸润、淀粉样变或核内包涵体形成(图2)。基因检测表明患者有1，4，5-三磷酸肌醇受体3型(ITPR3)基因杂合突变，患者母亲存在相同位点突变。结合患者症状、体征、肌电图、神经超声、神经磁共振、基因检测、神经活检及家族史，最终诊断为腓骨肌萎缩症1J型。患者目前症状轻微，以腰背酸胀和手背麻木为主，明确诊断后予营养神经、改善微循环等对症支持治疗，嘱出院后随诊。本研究已获得上海交通大学医学院附属第六人民医院伦理委员会审核批准(批号：2021-219)。患者对本研究知情同意并签署知情同意书。
Objective:This study aimed to explore whether cavitation generated by ultrasound-stimulated microbubbles (USMB) can enhance the therapeutic efficacy of colchicine and diminish its gastrointestinal side effects in rats with acute gouty arthritis (AGA). Materials and methods:The rat AGA model was established by injection of Monosodium urate (MSU) crystals. The rats were randomly divided into 6 groups (A: control group, B: model control group, C: cavitation group, D: high dose colchicine group, E: cavitation + low dose colchicine group, F: cavitation + high dose colchicine group) according to whether they were given cavitation and different doses of colchicine. The effect of cavitation on blood perfusion was analyzed by comparing contrast-enhanced ultrasound (CEUS) and the area under the curve (AUC) of CEUS with the ankle joint of right hind limb. The AGA symptoms were assessed by referring to the degree of ankle joint swelling within 24 h and the gait score. The infiltration of neutrophils was determined using the hematoxylin-eosin (HE) staining method. For the evaluation of vascular inflammation and dilation, plasma interleukin-1β (IL-1β) and endothelial nitric oxide synthase (eNOS) served as the key indicators. Besides, the severity of gastrointestinal adverse reactions is determined by analyzing the gastrointestinal reaction scores. Results:When compared with groups A, B, and D, the AUC was markedly higher in groups C, E, and F (all P < 0.05). In groups E and F, the degree of ankle swelling, gait scores, and the level of plasma IL-1β in AGA rats were lower, while the concentration of plasma eNOS was higher compared to the group D (all P < 0.05). HE staining findings demonstrated that the integration of cavitation and colchicine played a positive role in reducing neutrophil infiltration in the ankle joint synovium and mitigating the gastrointestinal reaction score in AGA rats. In contrast to groups D, E, and F that were given colchicine, group E had a substantially lower gastrointestinal reaction score, with statistically significant differences observed in pairwise comparisons (all P < 0.05). Conclusion:In rats with AGA, cavitation generated by USMB exerted a remarkable effect on augmenting the blood perfusion of the ankle joint. This, in turn, not only amplified the anti-gout efficacy of colchicine but also reduced the dosage of colchicine. Concurrently, it effectively mitigated the associated gastrointestinal side effects.
Objective:To assess the altered right atrial(RA) function using two-dimensional speckle-tracking imaging(2D-STI) in patients with persistent pulmonary hypertension of the newborn(PPHN), and investigate the diagnostic value of different right heart strain parameters in PPHN.Methods:Ultrasound images of 42 newborns with clinically confirmed diagnosis of PPHN in the neonatal intensive care unit of Shenzhen Children′s Hospital (median gestational age 37 + 1 weeks, median age 6 d) and 30 normal newborns (control group, median gestational age 37 + 3 weeks, median age 6.5 d) from January 2020 to January 2023 were retrospectively analyzed, all with gestational age ≥34 gestational weeks. 2D-STI was applied to evaluate RA function: RA strain(RA LS) and area change fraction(RA FAC), where RA LS included RA reservoir strain (εs), RA conduit strain (εe) and RA active contract strain (εa), while evaluating right ventricle(RV) function: RV global longitudinal strain(RV GLS), RV FAC, etc. And the degree of pulmonary artery pressure(PAP) was assessed by tricuspid regurgitation velocity(TRV). The above parameters were compared between the PPHN group and the control group, and the correlations between RA function parameters, RV function parameters and PAP in PPHN group were analyzed. The area under ROC curve (AUC) was used to compare the accuracy of each parameter in the evaluation of impaired cardiac function in PPHN patients. Results:Compared with the control group, RA function (εs, εe, εa and RA FAC) were impaired in PPHN patients (all P<0.05). εs was positively correlated with RV GLS, RA FAC ( r=0.494, 0.356, both P<0.05) and negatively correlated with minimum right atrial area (RAA min), pulmonary artery diameter (PAD), and tricuspid annular internal diameter ( rs=-0.285, r=-0.495, -0.396; both P<0.05); εe was negatively correlated with PAD ( rs=-0.256, P<0.05); εa was positively correlated with RV GLS ( r=0.499, P<0.05) and negatively correlated with PAD and tricuspid annular internal diameter ( r=-0.390, -0.380; both P<0.05); RA FAC was positively correlated with RV GLS ( r=0.365, P<0.05) and negatively correlated with PAD and tricuspid annular internal diameter ( r=-0.439, -0.328; both P<0.05). RA LS and RA FAC had no correlations with TRV-estimated PAP ( P>0.05). ROC analysis showed that the sensitivity and specificity of εs<40.50% for diagnosing PPHN was 0.905 and 0.800, respectively, with an AUC of 0.929; the sensitivity and specificity of RV GLS<18.55% for diagnosing PPHN were 0.905 and 0.900, respectively, with an AUC of 0.963; εs combined with RV GLS was the best indicator for early detection of right heart functional impairment in PPHN, with sensitivity and specificity of 0.905 and 1.000, respectively, and AUC was 0.985. Conclusions:RA function and RV function are both impaired in PPHN patients. εs combined with RV GLS is the best indicator for early assessment of right heart function impairment and diagnosis of PPHN.
Objective:To analyze the correlation between left and right atrial diameters and fetal biological growth parameters of normal fetuses in middle and late trimester, and to establish normal reference and Z-score model for left and right atria.Methods:Three hundred and ninety-two fetuses in middle and late trimester were prospectively selected from July 2022 to October 2022 in Sir Run Run Shaw Hospital.Non-cardiac biometric parameters included biparietal diameter (BPD), femoral length (FL), and gestational age (GA) based on menstrual age were assessed.Left and right atrial widths (LAW, RAW) and atrial lengths (LAL, RAL) at end-systole, left and right atrial areas (LAA, RAA) at end-systole and the heart area (HA) at end-diastole were measured in standard apical four-chamber or basal four-chamber view. The ratio of RA and LA transverse diameters (RAW/LAW), the ratio of RA and LA length diameters (RAL/LAL), ratio of RA and LA area (RAA/LAA), spherical index of the ratio of RA and LA length to transverse diameter (RASI, LASI), ratio of LA and RA area to heart area (LAA/HA, RAA/HA) were calculated. The best regression equation was established using GA, BPD and FL as independent variables and LAL, LAW, LAA, RAL, RAW, RAA as dependent variable. The correlation between the standard deviation (SD) and the independent variables GA, BPD and FL was analyzed, and then the above statistics were used to calculate the corresponding Z-score for each variable of RA and LA using the regression equation.Results:①Significant positive correlations were found between LAW, RAW, LAL, RAL, LAA and RAA with the increase of GA, BPD and FL, and the highest degree of correlation between RAA, LAA and GA was denoted ( r=0.927, 0.920, all P<0.001). ②Taking GA as an example, there was no significant correlation between RAL/LAL, RAW/LAW and GA ( r=-0.064, 0.077; all P>0.05). RAA/LAA showed a very weak positive correlation with GA ( r=0.106, P=0.037), with normal reference values of 1.002±0.091, 1.091±0.093, 1.059±0.090, respectively. Interestingly RAL/LAL was found close to 1, while RAW/LAW and RAA/LAA were always >1. No significant correlations were found between LAA/HA, RAA/HA and GA ( r=0.003, 0.056; all P>0.05), with normal reference values of 0.155±0.026, 0.163±0.026, respectively, and RAA/HA was found larger than LAA/HA. LASI showed a very weak positive correlation with GA ( r=0.112, P=0.027), while there was no significant correlation between RASI and GA ( r=0.003, P>0.05), the normal reference values were 1.068±0.113, 0.980±0.105, respectively. ③The SD of LAL, LAW, etc.showed a simple linear relationship with the independent variables. Taking RAA and GA as examples, the linear regression equation for RAA was Y=-1.690+ 0.107 0GA ( r=0.927, P<0.001) and the linear regression equation for RAA-SD was Y=-0.107+ 0.010 4GA ( r=0.320, P<0.001). The Z-scores for LAL, LAW, LAA, RAL, RAW and RAA were relatively constant with the growth of GA, BPD and FL, with the corresponding Z-scores for GA were -1.817~3.631( r=0.000 3), -1.605~2.995( r<-0.000 1), -1.700~3.107( r<0.000 1), -1.617~3.466( r=0.000 1), -1.491~3.025( r<-0.000 1), -1.566~3.104( r=0.000 2), respectively. Conclusions:This study preliminarily establish the reference value ranges and Z-score of atrial diameters in normal fetuses during middle and late trimester, providing a reference basis for accurate quantitative evaluation of fetal atrial development and analysis of fetal congenital heart abnormalities, and contributing to the early detection of pathological conditions leading to abnormal atrial size.
Objective:To investigate the changes of left atrial structure and function in patients with apical hypertrophic cardiomyopathy (ApHCM) by three-dimensional (3D) echocardiography.Methods:From September 2020 to December 2022, 112 patients with ApHCM(ApHCM group) diagnosed at Tongji Hospital Tongji Medical College, Huazhong University of Science and Technology and 41 age- and sex-matched normal controls(control group) were finally enrolled. In 'pure’ ApHCM patients, cardiac hypertrophy was confined to the apical segment below the papillary muscle. The wall thickness of apical and intermediate segments in 'mixed’ ApHCM patients increased, but the wall thickness of apical segment was the largest. Two-dimensional(2D) and 3D volume and strain parameters of left atrium were compared between control group and ApHCM group, 'pure’ and 'mixed’ ApHCM patients.The correlations between 2D and 3D volume and strain parameters of left atrium and intraclass correlation coefficient (ICC) of those parameters were analyzed. The ROC curve was performed to determine the cutoff values of 3D left atrial volume abnormalities in all subjects. Logistics regression analysis was performed to analyze the impact factors of the left atrial enlargement in patients with ApHCM.Results:Compared with the control group, 2D left atrial maximum volume index (2D LAVimax), 2D left atrial minimum volume index (2D LAVimin), 3D left atrial maximum volume index (3D LAVimax), 3D left atrial minimum volume index (3D LAVimin), and 3D left atrial presystolic volume index (3D LAVipreA) significantly increased in ApHCM group( Z=-6.54, -6.38, -6.98, -7.40, -6.96; all P<0.001). However, 2D left atrial ejection fraction (2D LAEF) ( Z=-3.75, P<0.001), 2D left atrial expansion index (2D LAEI) ( t=-4.15, P<0.001), 3D left atrial ejection fraction (3D LAEF) ( Z=-5.09, P<0.001), 3D left atrial expansion index (3D LAEI) ( t=-5.49, P<0.001), 2D left atrial reservoir strain (2D LASr) ( t=-12.03, P<0.001), 2D left atrial conduit strain (2D LAScd) ( t=7.91, P<0.001), 2D left atrial contractile strain (2D LASct) ( t=6.06, P<0.001), 3D left atrial reservoir strain (3D LASr) ( t=-9.23, P<0.001), 3D left atrial conduit strain (3D LAScd) ( t=7.12, P<0.001) and 3D left atrial contractile strain (3D LASct) ( t=4.78, P<0.001) significantly decreased in ApHCM group. Compared with the 'pure’ ApHCM group, 2D LAVimax, 3D LAVimax, 2D LAVimin, 3D LAVimin, 3D LAVipreA in patients with mixed ApHCM increased more significantly, while 2D LAEF, 2D LAEI and 2D LASr decreased more significantly. The measurements of left atrial volume and strain by 3D echocardiography were significantly correlated with 2D measurements ( P<0.05). The correlations between 2D LAVimax and 3D LAVimax, 2D LAVimin and 3D LAVimin, 2D LAEF and 3D LAEF, 2D LASr and 3D LASr, 2D LAEI and 3D LAEI ( r=0.91, 0.93, 0.72, 0.76, 0.57; all P<0.05) were more than moderate. The repeatability of 3D left atrial strain was lower than 2D results, while the repeatability of 3D left atrial volume was higher than 2D results. ROC curve analysis showed that 3D echocardiography parameters could identify left atrial volume abnormality in all subjects. The cutoff values of 3D LAVimax, 3D LAVimin, 3D LAVipreA in all subjects were 36 ml/m 2, 18 ml/m 2 and 27 ml/m 2, respectively. Multivariate binary logistic regression analyses showed that ratio of LV systolic obliteration to cavity was independent factor affecting left atrial enlargement in ApHCM patients( OR=1.20, P<0.001). Conclusions:Three-dimensional echocardiography is significant for the accurate evaluation of left atrial structural changes in patients with ApHCM. Ratio of left ventricular systolic obliteration to cavity was an independent impact factor of left atrial enlargement in ApHCM patients.
Objective:To develop an artificial intelligence (AI) quality control model of fetal heart in the first trimester and verify its effectiveness.Methods:A total of 18 694 images of the four-chamber view(4CV) and three-vessel and tracheal view(3VT) of fetal heart in the first trimester were selected from Shenzhen Maternal and Child Health Hospital Affiliated to Southern Medical University since January 2022 to December 2022. A total of 14 432 images were manually annotated. The one-stage target detection algorithm YOLO V5 was used to train the AI quality control model in the first trimester of fetal heart, and 4 262 images (golden standard set by expert group) were used to evaluate the application effectiveness of AI quality control model. Kappa consistency test was used to compare the results of section classification and standard degree judgment from AI quality control model, Doctor 1(D1) and Doctor 2(D2).Results:①Precision of the AI quality control model was 0.895, recall was 0.852, mean average precision (mAP 50) was 0.873.The average precision(AP) of the AI quality control model for section classification was 0.907 (4CV) and 0.989 (3VT), respectively. ②Compared with the gold standard, the overall coincidence rate and consistency of section classification of AI quality control model, D1 and D2 were 99.91% (Kappa=0.998), 100% (Kappa=1.000), 100% (Kappa=1.000), respectively. The coincidence rate and consistency of the plane standard degree evaluation from the AI quality control model, D1 and D2 were 97.46% (Weighted Kappa=0.932), 93.73% (Weighted Kappa=0.847), and 93.12% (Weighted Kappa=0.832), respectively. Strong consistency was displayed. Moreover, AI quality control model showed the highest coincidence rate and the strongest consistency in judging section standard degree, which was superior to manual quality control. The time-consuming of AI quality control (0.012 s/sheet) was significantly less than the way of manual quality control (4.76-6.11 s/sheet)( Z=-8.079, P<0.001). Conclusions:The use of artificial intelligent fetal heart quality control model in the first trimester can effectively and accurately control the image quality.
在过去的十余年，国内外对胎儿先天性心脏病(congenital heart disease，CHD)的产前筛查与诊断、遗传咨询、产前产后管理等领域的认识发生了巨大变化 [1,2,3,4,5,6]，有效的胎儿心脏超声筛查和最大程度准确诊断胎儿CHD、胎儿心律失常及胎儿心脏功能改变已经成为产前医疗工作中非常重要的部分。在2013年国际妇产超声学会(The International Society of Ultrasound in Obstetrics and Gynecology，ISUOG)发布的胎儿心脏超声筛查指南 [4]的基础上，2023年6月ISUOG发布了最新胎儿心脏超声筛查指南 [7](以下简称"指南")， 适用于中孕期低危妊娠的胎儿心脏超声筛查。"指南"指出，在技术可行的条件下，也可以在早孕期和中孕早期开展胎儿心脏超声筛查。该"指南"还鼓励在胎儿心脏超声筛查中使用彩色多普勒血流成像技术，首次对胎儿心脏超声筛查质量控制的基本内容进行了阐述，并建议采用检查清单 [7]。产前医疗专家也可参照该指南对存在染色体异常的高危妊娠进行心脏超声筛查、及时指导此类孕妇的产前咨询、管理及多学科诊疗活动。对疑诊胎儿CHD或CHD高危妊娠孕妇应建议进行全面系统的胎儿超声心动图检查。以下对该指南的主要内容进行解读。
我国目前有临床诊断的冠状动脉性心脏病(简称冠心病)患者1 130余万，冠心病诊治技术仍以冠状动脉有创性检查为主 [1]。然而，新近临床研究显示82%接受有创冠状动脉造影检查的患者无需介入治疗 [2]。为了规范冠心病心肌缺血临床诊断和治疗策略的路径，现有国际指南明确提出负荷影像学检查是慢性胸痛确诊或疑似冠心病患者首选的诊断方法，负荷超声心动图(stress echocardiography，SE)是稳定性心绞痛患者的Ⅰ类推荐检查技术 [3]。
Objective:To evaluate the degree of left atrial fibrosis in patients with persistent atrial fibrillation(AF) using four-dimensional automic left atrial quantitation(4D Auto LAQ).Methods:A total of 60 patients with persistent AF who underwent transcatheter radiofrequency ablation in the Second Hospital of Hebei Medical University from March 2022 to March 2023 were included. Patients were grouped according to the low-voltage area (mild<5%, moderate 5%-20%, severe>20%). General clinical data, conventional echocardiogram parameters, left atrial strain and related parameters of each group were compared. The relevant factors were obtained by Logistic regression analysis. The factor with the highest accuracy and its cut-off value was obtained by the ROC curve.Results:Sixty patients with persistent atrial fibrillation, were divided into mild low-voltage group(22 cases), moderate low-voltage group(20 cases), and severe low-voltage group(18 cases). There were statistical differences in gender, CHA2DS2-VASc score, peak value of early diastolic velocity of mitral inflow/average peak value of early diastolic tissue Doppler velocity of mitral annulus (E/e′), left atrial diameter (LAD), left atrial volume index (LAVI), left atrial maximal volume (LAVmax), left atrial minimal volume (LAVmin), left atrial total emptying fraction (LAEF), left atrial reservoir longitudinal strain (LASr), left atrial reservoir circumferential strain (LASr-c), left atrial myocardial work (LA MW, LA MW-c), left atrial stiffness (LA stiffness, LA stiffness-c) among the 3 groups(all P<0.05). The LASr had the highest correlation with low voltage area ( rs=-0.814, P<0.001). Logistic regression analysis showed that CHA2DS2-VASc, LAD, LAVI, LAVmax, LAVmin, LAEF, LASr, LASr-C, LA MW, LA MW-C, LA stiffness and LA stiffness-c could all predict the low voltage area(all P<0.05). The LA stiffness had the highest AUC (0.952). The cut-off value of severe low voltage was 1.15, the sensitivity was 94.4%, and the specificity was 83.3%. Conclusions:4D Auto LAQ can be used to evaluate the degree of left atrial fibrosis. The correlation between LA stiffness and substrate voltage mapping is the highest.
十一月的海南，碧空如洗，天朗气清，惠风和畅。由中华医学会(以下简称：学会)、中华医学会超声医学分会(以下简称：分会)主办的"中华医学会第二十三次全国超声医学学术会议"(以下简称：会议)于2023年11月9日至12日在椰城海口如期召开。本次会议是一次集中展示与总结国内外超声医学领域最新研究成果、分享临床发展动态的大会，从基础到临床、从理论到实践、从学科建设发展战略到诊疗应用技术，会议满载新意和热情，呈现了一场久别重逢后的学术盛宴。
甲状腺结节超声恶性危险分层中国指南(C-TIRADS)作为中国首个甲状腺成像报告与数据系统，兼顾分类的准确性及临床易用性，适应目前我国甲状腺结节诊治流程；如果联合其他超声新技术，如弹性成像、造影、人工智能等，则可以提高其诊断效能。笔者对C-TIRADS的临床应用价值、局限性及与其他超声技术联合应用进行综述。
Objective:To evaluate the right atrial volume and function abnormalities in patients with pulmonary hypertension (PH) by four-dimensional automatic quantitation technique, and to explore the application value of this technique in evaluating the risk stratification and World Health Organization functional class(WHO-FC) of PH patients.Methods:Eighty-four adult patients with PH diagnosed by right heart catheterization from April to October 2022 in Fuwai Central China Cardiovascular Hospital were consecutively enrolled as the PH group. All cases were divided into 3 groups according to the mean pulmonary arterial pressure (mPAP): mild PH group ( n=28), moderate PH group ( n=28), severe PH group ( n=28). Twenty-eight healthy volunteers matched by gender and age were included in the same period as the control group. The volume and strain parameters of the right atrium were obtained by analyzing the four-dimensional image of the right atrium using four-dimensional automatic quantitation technique, including right atrial minimum volume index (RAVImin), right atrial maximum volume index (RAVImax), right atrial presystolic volume index (RAVIpreA), right atrial ejection fraction (RAEF), right atrial passive ejection fraction (RAPEF), right atrial active ejection fraction, RAAEF, longitudinal strains of right atrial reserve, conduit and systolic period (RASr, RAScd, RASct), circumferential strains of right atrial reserve, conduit and systolic period (RASr-c, RAScd-c, RASct-c). The differences in right atrial parameters among four groups were compared.ROC curve was used to analyze the diagnostic efficiency of right atrial four-dimensional strain parameters for PH patients with WHO-FC≥Ⅲ. Pearson linear correlation analysis was used to investigate the relationships between RASr and right atrial area (RAA), NT-proBNP and tricuspid annular plane systolic excursion to pulmonary arterial systolic pressure ratio (TAPSE/sPAP). Results:①Compared with the control group, RAEF, RAPEF, RASr, RAScd, RASr-c, RAScd-c were significantly decreased in mild, moderate and severe PH groups; while RAAEF, RASct, RASct-c were significantly increased in mild PH group and significantly decreased in moderate and severe PH groups, and the differences were statistically significant (all P<0.05). RAVImin, RAVImax, RAVIpreA gradually increased among the control, mild PH, moderate PH and severe PH groups, and the differences were statistically significant (all P<0.05). RAEF, RAPEF, RAAEF, RASr, RAScd, RASct, RASr-c, RAScd-c, RASct-c were decreased successively among mild, moderate and severe PH groups, and the differences were statistically significant (all P<0.05). ②ROC curve showed that RASr had the highest diagnostic efficiency in PH patients with WHO-FC ≥Ⅲ, and the cut-off value was 20.5% (AUC=0.914, P<0.001). ③Correlation analysis showed that RASr was correlated with RAA, NT-proBNP and TAPSE/sPAP ( r=-0.803, -0.621, 0.739; all P<0.001). Conclusions:The degree of right atrial function impairment increased in patients with mild, moderate and severe PH in turn. RASr is the best predictor of WHO-FC ≥Ⅲ in patients with pulmonary hypertension and is a potential parameter for risk stratification in patients with PH.
《中华超声影像学杂志》第八届编委会第二次工作会议于11月9日在海南国际会议中心召开。中华医学会杂志社社长兼总编辑魏均民编审，第八届编委会总编辑、中华医学会超声医学分会前任主任委员姜玉新教授，第八届编委会副总编辑、中华医学会超声医学分会主任委员梁萍教授，第八届编委会副总编辑、中华医学会超声医学分会候任主任委员李建初教授，第八届编委会副总编辑、中华医学会超声医学分会副主任委员郑元义教授、张梅教授、蒋天安教授、谢明星教授，河北医科大学党委常委、副校长张振宇出席会议。会议由李建初教授主持。
Objective:To retrospectively analyze the contrast-enhanced ultrasound(CEUS) features of primary hepatic lymphoepithelioma-like carcinoma (LELC) and investigate the value of CEUS in the diagnosis of hepatic LELC.Methods:The images of CEUS of 12 cases with hepatic LELC were retrospectively analyzed. The perfusion patterns and time of enhancement were observed.Results:During the arterial phase, 11 lesions showed diffuse enhancement, while 1 lesion showed rim-like enhancement. The mean time of begin enhancement, time to peak, time to iso-enhancement and slightly hypo-enhancement were (17.92±5.81)s, (24.50±5.52)s, (29.55±6.25)s, (45.50±25.15)s, respectively. Compared with adjacent liver parenchyma, rapid enhancement was observed in 11 lesions and synchronous enhancement was observed in 1 lesion.As to time of peak enhancement, hyper-enhancement and iso-enhancement were observed in 11 lesions and 1 lesion, respectively. In portal phase, 8 lesions manifested slight hypo-enhancement, 3 lesions with marked hypo-enhancement and 1 lesion with iso-enhancement.And in delayed phase, 10 lesions showed marked hypo-enhancement and 1 lesion with slight hypo-enhancement. Ten lesions showed peripheral hyper-enhancement like a bright ring in the portal and delayed phase.Conclusions:CEUS is valuable for the diagnosis and differential diagnosis of hepatic LELC.
Objective:To investigate the diagnostic value of ultrasound contrast agent enema (UCAE) for anastomotic leakage (AL) after rectal cancer surgery.Methods:From January 2020 to December 2022, a total of 95 patients with presacral fluid collection after rectal cancer surgery in the Sixth Affiliated Hospital of Sun Yat-sen University who received perineal ultrasound (PNUS) and UCAE were retrospectively selected. Among them, 70 patients (73.3%) were diagnosed with AL.After PNUS scanning, all patients received a diluted ultrasound contrast agent administered through the rectum. Receiver operating characteristic (ROC) curve were used to compare the accuracies of PNUS, UCAE, CT, MRI and water-soluble contrast enema in the diagnosis of AL. Factors that may have impacts on the sensitivity of UCAE were thoroughly analyzed.Results:UCAE improved the consistency (Kappa value: 0.757 vs 0.292, P<0.001) and accuracy (AUC: 0.893 vs 0.693, P<0.001) of PNUS in the diagnosis of AL, and its diagnostic accuracy was comparable to that of CT (AUC 0.807), MRI (AUC 0.811) and water-soluble contrast enema (AUC 0.923) (all P>0.05). For mid-to-high AL (anastomotic stoma distance ≥70 mm) and tiny AL (≤3 mm), the sensitivity of UCAE decreased significantly (anastomotic stoma position: 25.0% vs 85.5%, P=0.001; anastomotic leak diameter: 42.9% vs 87.5%, P=0.002). Conclusions:UCAE can significantly improve the diagnostic accuracy and consistency of PNUS for AL after rectal cancer surgery, and its diagnostic sensitivity is affected by the anastomotic stoma distance and the diameter of the leak.
Objective:To explore the potential of thrombus-targeted nanoprobes for ultrasound/near-infrared bimodal imaging and their synergistic therapeutic effects on thrombosis in vitro.Methods:Nanoprobes loaded with arginine-glycine-aspartate peptide (RGD), perfluoropentane (PFP) and indocyanine green (ICG) were prepared by ultrasonic vibration and carbodiimide method with mesoporous silica nanoparticle (MSN) as the carrier. The probe morphology was observed by scanning and transmission electron microscopy. The loading of RGD and ICG was detected by Bicinchoninic Acid Assay (BCA) and UV-Visible-NIR spectroscopy respectively. The imaging performance and photothermal response of the nanoprobe under near infrared light (NIR) irradiation were studied in vitro. Its biological safety was tested by cytotoxicity test and hemolysis test. The phase transformation was studied under ultrasound and NIR irradiation. The nanoprobe was incubated with fresh arterial thrombus, and its target-seeking ability was observed by frozen section. Ultrasound and NIR irradiation were used to evaluate its thrombolytic ability by the weight changes of thrombus before and after irradiation.Results:The prepared nanoprobe had regular morphology and uniform size. The particle diameter was (156.83±5.05)nm, and the surface potential was (11.47±0.25)mV. The RGD coupling rate was (77.67±4.50)%, which could mediate the targeting of nanoprobe to fresh extracorporeal arterial thrombus. UV-Visible-NIR spectroscopy confirmed the successful loading of ICG, and its encapsulation rate was (80.47±0.05)%. After ultrasound and NIR irradiation, the nanoprobe could undergo acoustically induced phase transition, thermally induced phase transition and enhance the ultrasonic development effect. With the increase of the concentration of the nanoprobe solution, the NIR signal gradually increased, and the temperature rose in a concentration-dependent and intensity-dependent manner after NIR irradiation. The cytotoxicity test and hemolysis test showed that the nanoprobe had good biological safety, and it could play a thrombolytic role under the combined irradiation of ultrasound and NIR, and the weight of thrombus was significantly reduced after the treatment ( P<0.01). Conclusions:In this study, the nanoprobe (RGD/ICG/PFP@MSN) were successfully prepared possesses excellent dual mode imaging capabilities of ultrasound and NIR, excellent phase transition ability and photothermal conversion efficiency, as well as efficient targeted penetration and therapeutic effects against thrombosis. This study provides strong in vitro experimental evidence and new strategies for the integration of diagnosis and treatment of thrombotic diseases under the cooperation of ultrasound and NIR.
