Abstract Background Peritonitis is a common serious complication of peritoneal dialysis. Although peritoneal thickening is commonly observed in long-term peritoneal dialysis patients, there have been relatively few studies on mesenteric and intestinal wall alterations through ultrasonography, particularly in pediatric patients. We aim to determine the value of ultrasonographic measurement in children with peritoneal dialysis-related peritonitis. Methods We recruited two groups of pediatric patients, of whom 40 had peritonitis (study group) and 42 had no peritonitis (control group). We measured peritoneal, mesenteric and intestinal wall thickness by trans-abdominal ultrasonography. To identify risk factors and develop a predictive nomogram for peritonitis, we employed multivariate logistic regression analysis. Subsequently, the performance of the nomogram model was assessed through the ROC curve, calibration curve, and decision curve analysis (DCA). Results The ultrasonographic measurements of the peritoneal thickness, mesenteric thickness, jejunal wall and ileal wall thickness in peritonitis group were significantly thicker than the non-peritonitis group. The peritonitis group had significantly higher NLR (neutrophil-to-lymphocyte ratio) and significantly lower albumin and uric acid levels than the non-peritonitis group. Multivariate Logistic analysis showed that dialysis duration, mesenteric thickness, jejunal wall thickness and NLR were potential associated factors. ROC curve showed that the integrated predictive model exhibited superior diagnostic accuracy (AUC = 0.873) over that of any single predictive parameter ( P < 0.05). The nomogram model showed good calibration and clinical benefit. Conclusions High-frequency ultrasound effectively supports the diagnosis of peritoneal dialysis-related peritonitis. The integrated predictive model based on ultrasonographic measurements is effective for predicting the recurrent PD-related peritonitis in children and offering practical ultrasonographic criteria.

BACKGROUND:Intrahepatic cholangiocarcinoma (ICC) represents the second-most prevalent primary hepatic malignancy, demonstrating increasing worldwide occurrence. Although surgical methods have progressed, outcomes following curative resection remain suboptimal due to substantial recurrence frequencies. Recurrence occurring early, usually during the initial postoperative year, indicates aggressive tumor characteristics and predicts inferior outcomes compared with delayed recurrence. Comprehending patterns and predictive indicators of early relapse is essential for refining postoperative monitoring approaches and directing adjuvant treatment choices. The present investigation concentrated on determining risk indicators and recurrence characteristics to enhance personalized patient management strategies for ICC. AIM:To determine the characteristics and predictive indicators of early disease recurrence following curative surgical resection of ICC. METHODS:We conducted a retrospective evaluation of 386 consecutive individuals who received curative surgical resection for ICC at our institution during the period spanning January 2017 through December 2021. Early disease recurrence was operationally defined as tumor relapse occurring within the first 12 postoperative months. Predictive indicators were examined through univariate and multivariate Cox proportional hazards regression analyses. RESULTS:Within our cohort of 386 individuals, 237 patients (61.4%) demonstrated disease recurrence throughout the observation period, with 178 cases (75.1%) manifesting early recurrence. The predominant anatomical locations of recurrent disease included hepatic tissue (66.7%), regional lymph nodes (18.1%), and peritoneal surfaces (8.0%). Independent predictive indicators of early recurrence encompassed: Neoplasm diameter exceeding 5 cm [hazard ratio (HR) = 2.14, 95% confidence interval (CI): 1.52-3.01, P < 0.001], presence of multiple tumor foci (HR = 1.89, 95%CI: 1.34-2.67, P < 0.001), metastatic lymph node involvement (HR = 2.43, 95%CI: 1.71-3.45, P < 0.001), microscopic vascular invasion (HR = 1.76, 95%CI: 1.25-2.48, P = 0.001), carbohydrate antigen 19-9 concentrations surpassing 200 U/mL (HR = 1.92, 95%CI: 1.37-2.69, P < 0.001), and incomplete surgical margins (HR = 2.01, 95%CI: 1.38-2.93, P < 0.001). Individuals experiencing early recurrence demonstrated markedly reduced overall survival relative to those with delayed recurrence (median: 18.5 months vs 42.3 months, P < 0.001). CONCLUSION:Early disease recurrence following ICC resection occurs frequently and correlates with unfavorable clinical outcomes. Several neoplasm-associated and treatment-associated characteristics predict early relapse. These indicators can facilitate identification of patients at elevated risk who might benefit from intensive monitoring protocols or adjuvant therapeutic interventions.

Background:Intraoperative localization of pulmonary nodules (PNs) is a technical support for video-assisted thoracic surgery (VATS). Failure to accurately localize PNs will necessitate conversion to conventional open chest surgery or transfer to the hybrid operation room, which highlights the importance of intraoperative ultrasound (IOUS) for identifying lesions. We found that PNs could be better visualized with the help of artificial pleural effusion (APE). Therefore, the aim of this study was to investigate the feasibility of APE-assisted IOUS for the visualization of PNs. Methods:Patients who underwent VATS from December 2023 to August 2024 were included in this study. APE was established using saline, and APE-assisted IOUS was applied to localize and make the initial determination of nature. After identifying the suspicious lesions, the surface of the lobe where the nodules were located was marked. The feasibility of APE-assisted IOUS for identifying the nodules was determined based on pathology. Results:In total, 16 PNs of 15 patients included were successfully identified with APE-assisted IOUS. Spearman's correlation analysis showed that there was a significant correlation between the maximum diameter of pulmonary lesions measured by preoperative computed tomography (CT) and IOUS (ρ=0.889, P<0.01). The median localization time with APE-assisted IOUS was 1.00 minute. Conclusions:APE-assisted IOUS can accurately localize PNs, minimizing surgical time and increasing the efficiency of resection.

OBJECTIVE:This study aims to evaluate the value of Kupffer phase imaging with Sonazoid-Contrast-Enhanced Ultrasound (CEUS) in differentiating atypical Hepatocellular Carcinoma (HCC) from Focal Nodular Hyperplasia (FNH), compared to the efficacy of Gadodiamide-Enhanced Magnetic Resonance Imaging (CEMRI). METHODS:We retrospectively reviewed a total of 56 focal liver lesions, comprising 36 atypical HCC and 20 FNH lesions, which were examined pre-operatively using both CEUS and CEMRI. Features were extracted from the images obtained from both modalities. The diagnostic performance of these features was evaluated using the Area Under the Receiver Operating Characteristic Curve (AUC). RESULTS:In the multivariate analysis, HBsAg-positive status (OR = 8.395, p = 0.021) and hypo-enhancement in the Kupffer phase (OR = 5.276, p = 0.042) were identified as independent predictors of atypical HCC. The specificity and sensitivity of HBsAg-positive for diagnosing atypical HCC are 65.0 % and 91.7 %, respectively. The specificity and sensitivity of hypo-enhancement in the Kupffer phase for diagnosing atypical HCC are 95.0 % and 63.9 %, respectively. Significantly, by integrating CEUS diagnostic characteristics to distinguish atypical HCC from FNH, we attained a specificity of 100.0 %, a sensitivity of 63.9 %, and a diagnostic accuracy of 76.8 %. Similarly, the combination of CEMRI diagnostic features resulted in a specificity of 100.0 %, a sensitivity of 47.2 %, and an overall diagnostic accuracy of 66.1 %. CEUS's diagnostic accuracy is superior to CEMRI and this difference is statistically significant (P < 0.05). CONCLUSION:Sonazoid-CEUS demonstrates significant clinical potential and is a viable tool for the differential diagnosis of atypical HCC and FNH.

Perfluorobutane microspheres–based contrast-enhanced US targeting alternatively activated phenotype tumor-associated macrophages helped predict response to anti–programmed cell death-1 therapy in hepatocellular carcinoma models.

Abstract Objective This study aims to assess the diagnostic performance of Sonazoid-contrast-enhanced ultrasound (CEUS) in identifying definitive HCC within hepatic nodules in cirrhotic patients, comparing the KLCA-NCC 2022 and APASL 2017 diagnostic guidelines. Materials and methods This retrospective study analyzed cirrhotic patients who underwent Sonazoid-CEUS for liver lesion evaluation between October 2019 and October 2023. HCC diagnosis was based on the KLCA-NCC 2022 and APASL 2017 guidelines. Inter-reader agreement on CEUS imaging features and the diagnostic accuracy of the guidelines were evaluated. Sensitivity and specificity comparisons were made using McNemar’s test. Results Among 400 patients with 432 lesions, CEUS showed excellent inter-reader consistency in detecting arterial phase hyperenhancement and Kupffer defects. The KLCA-NCC 2022 criteria notably enhanced sensitivity to 96.2%, with specificity and accuracy of 93.8% and 95.8%, respectively. APASL 2017 achieved the highest sensitivity at 97.8%, although specificity dropped to 46.9%, resulting in an accuracy of 90.3%. The KLCA-NCC 2022 guidelines demonstrated significantly higher specificity than APASL 2017 (p < 0.001), while APASL 2017 exhibited the highest sensitivity at 97.8%. Notably, the KLCA-NCC 2022 guidelines also demonstrated an impressive positive predictive value of 98.9%. Conclusion Sonazoid-enhanced CEUS, particularly when applied using the KLCA-NCC 2022 guidelines, is an effective diagnostic tool for HCC. Critical relevance statement Perfluorobutane CEUS, particularly in accordance with the KLCA-NCC 2022 guidelines, emerges as a valuable adjunct for diagnosing HCC in cirrhotic patients. It demonstrates superior positive predictive value and specificity compared to APASL 2017, underscoring its potential as an effective diagnostic tool. Key Points Contrast-enhanced (CE)US using Sonazoid with KLCA-NCC 2022 guidelines is highly effective for HCC diagnosis. KLCA-NCC 2022 criteria showed high accuracy, 96.2% sensitivity, and 98.9% PPV. CEUS demonstrated excellent inter-reader consistency in detecting arterial phase hyperenhancement and Kupffer defects. Graphical Abstract

Early recurrence (ER) after surgery is related to early death in patients with hepatocellular carcinoma (HCC) after radical resection. To explore the role of preoperative contrast-enhanced ultrasound (CEUS) in predicting ER of HCC after curative resection and to stratify the risk of ER. This study evaluated consecutive 556 patients with HCC who were examined by CEUS during the 2 weeks before curative resection between January 2011 and December 2018. ER was defined as intrahepatic and/or extrahepatic recurrence within 2 year after resection of HCC. Univariate and logistic regression analyses were performed to identify independent risk factors for ER after surgical resection of HCC. Recurrence-free time (RFS) rates were analyzed and compared by log-rank test. ER occurred in 307 (55.2

BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) is a highly malignant and aggressive tumor, and high Ki-67 expression indicates poor histological differentiation and prognosis. Therefore, one of the challenges in diagnosing preoperatively patients with PDAC is predicting the degree of malignancy. Dynamic contrast-enhanced ultrasonography (DCE-US) plays a crucial role in abdominal tumor diagnosis, and can adequately show the microvascular composition within the tumors. However, the relationship between DCE-US and the Ki-67 labelling index remains unclear at the present time. AIM To predict the correlation between Ki-67 expression and the parameters of DCE-US. METHODS Patients with PDAC who underwent DCE-US were retrospectively analyzed. Patients who had received any treatment (radiotherapy or chemotherapy) prior to DCE-US; had incomplete clinical, imaging, or pathologic information; and had poor-quality image analysis were excluded. Correlations between Ki-67 expression and the parameters of DCE-US in patients with PDAC were assessed using Spearman’s rank correlation analysis. The diagnostic performances of these parameters in high Ki-67 expression group were evaluated according to receiver operating characteristic curve. RESULTS Based on the Ki-67 labelling index, 30 patients were divided into two groups, i.e. , the high expression group and the low expression group. Among the relative quantitative parameters between the two groups, relative half-decrease time (rHDT), relative peak enhancement, relative wash-in perfusion index and relative wash-in rate were significantly different between two groups (P = 0.018, P = 0.025, P = 0.028, P = 0.035, respectively). The DCE-US parameter rHDT was moderately correlated with Ki-67 expression, and rHDT ≥ 1.07 was more helpful in accurately diagnosing high Ki-67 expression, exhibiting a sensitivity and specificity of 53.8% and 94.1%, respectively. CONCLUSION One parameter of DCE-US, rHDT, correlates with high Ki-67 expression. It demonstrates that parameters obtained noninvasively by DCE-US could better predict Ki-67 expression in PDAC preoperatively.

Purpose: This study aimed to investigate the use of contrast-enhanced ultrasonography (CEUS) to assess the kidneys' quality before procurement.Methods: This prospective study included 74 donors and 148 recipients of kidneys.119 kidneys underwent quantitative analysis.Before organ procurement, potential kidney donors underwent CEUS, though organ procurement involved a zero-point puncture biopsy.CEUS parameters of the renal cortex and medulla were evaluated, including rise time (RT), time to peak (TTP), the area under the curve (AUC), wash-in slope (WIS), peak intensity (PI), and mean transit time (MTT).Donors' kidneys were classified based on their pathological.Additionally, short-term clinical indicators of renal recipients were collected and analyzed to determine whether the patients had delayed recovery of renal allograft function.Results: This experiment included 148 cases of kidney information, divided into two groups based on the Remuzzi score of the kidneys.However, 29 kidneys were excluded from the quantitative analysis due to loss or low quality of CEUS images.Comparing the time-intensity curve (TIC) of renal cortical region of interest (ROI), we found that the group with lower pathological scores exhibited higher PI (P=0.002),AUC(P=0.003), and WIS (P=0.009).TIC comparison results for renal medulla ROI revealed that the group with lower pathological scores had higher PI (P=0.010),AUC (P=0.023), and WIS (P=0.024).Conclusions: This study highlighted the potential of CEUS as a non-invasive, safe, and real-time examination method that correlates with the Remuzzi score and renal pathology.Therefore, it can be used as a prospective preoperative non-invasive evaluation method for the donor's kidney.

BACKGROUND The most primary sites of angiosarcoma are the skin, breast gland, and soft tissues. Primary hepatic angiosarcoma (PHA) is a rare malignant tumor of mesothelial tissue originating from the liver. PHA often presents with multiple intrahepatic foci or metastasis at the time of presentation due to its nonspecific clinical presentation and highly aggressive nature. There are no established or effective treatment guidelines for PHA, so early detection and early treatment are of great value for patient survival. Unfortunately, there is a paucity of literature on the imaging features of PHA, making the diagnosis and treatment of this disease a considerable challenge. CASE SUMMARY In this case report, we present a 59-year-old man who initially presented with abdominal pain and radiating pain in the right shoulder. Magnetic resonance imaging and positron emission tomography-computed tomography revealed multiple intrahepatic nodules that needed to be differentiated from tumors of vascular epithelial origin and tumors with progressive enhancement features, and signs of tumor metastasis were assessed. The patient was then subjected to contrast-enhanced ultrasonography (CEUS) to further clarify the extent of tumor infiltration and the state of microcirculatory perfusion. The manifestations observed on CEUS were similar to the classical characteristic presentation of hepatocellular carcinoma, called "quick wash-in and quick wash-out". In addition, CEUS showed that the lesion exhibited gradual infiltration and growth along the liver pedicle structures with no invading blood vessels. Finally, based on pathological and immunohistochemical tests and the above imaging manifestations, it was confirmed that the patient had infiltrating PHA, which is a rare pathological type of PHA. The patient underwent transcatheter arterial chemoembolization and chemotherapy. Four months after the onset of symptoms, the follow-up radiological examination revealed poor treatment efficacy and rapid deterioration. CONCLUSION This case report complements the imaging modalities of a rare infiltrative PHA, in which CEUS and quantitative analysis are found to offer substantial advantages in characterizing the microcirculatory perfusion of the lesion, providing clinicians with diagnostic information at the earliest opportunity to make a diagnosis and develop a treatment strategy to prolong the patient survival.

Objective: This study aims to evaluate and compare the predictive accuracy of Sonazoid-contrast-enhanced ultrasound (CEUS) and Gd-EOB-DTPA-enhanced MRI for detecting microvascular invasion (MVI) in hepatocellular carcinoma (HCC). Methods: In this single-center prospective study, we included 64 patients with histopathologically confirmed single HCC lesions. Based on post-operative pathologic data, patients were categorized into two groups: those with MVI (n = 21) and those without MVI (n = 43). The diagnostic efficacy of CEUS was compared with that of MRI in predicting MVI. Results: Multifactorial analysis revealed that US features (tumor size > 4.35 cm, peritumoral enhancement, postvascular ring enhancement, peak energy in the arterial phase of the difference between the margin area of HCC and distal liver parenchyma <-1.0 x 106 a.u), MRI features (rim enhancement, irregular tumor margin, and the halo sign) were all independent predictors of MVI (p <0.05). The sensitivity and specificity of CEUS features in predicting MVI ranged from 61.9% to 86.4% and from 42.9% to 71.4%, respectively. For MRI features, the sensitivity and specificity ranged from 33.3% to 76.3% and from 54.7% to 90.5%, respectively. No statistically significant differences were observed in the area under the curve between CEUS and MRI (p > 0.05). Notably, peak energy of the difference showed the highest sensitivity at 86.4%, while the halo sign in MRI exhibited the highest specificity at 90.5%. Conclusion: Sonazoid-CEUS and Gd-EOB-DTPA-enhanced MRI demonstrate potential in predicting MVI in HCC lesions. Notably, CEUS showed higher sensitivity, whereas MRI displayed greater specificity in predicting MVI.

Background: High rate of recurrence impaired the prognosis of hepatocellular carcinoma (HCC) after surgery. We aimed to explore the safety and efficacy of neoadjuvant drug-eluting bead transarterial chemoembolization (DTACE) and tislelizumab therapy for resectable or borderline resectable HCC. Methods: 41 HCC patients received neoadjuvant therapy and surgery were respectively enrolled. The safety and efficacy of the neoadjuvant therapy were assessed. The prognosis was evaluated and compared with that of 41 matched HCC patients who received surgery alone. Results: 36 (87.8%) patients had adverse events (AEs) and only one patient had a grade 3/4 of ALT elevated. All patients performed surgery successfully and no severe postoperative complications occurred. The objective response rate (ORR) was 56.1% and 87.8% based on RECIST 1.1 and mRECIST, respectively. 15 (36.6%) patients had radiological complete tumor necrosis and the disease control rate (DCR) was 100%. The pathological complete response (pCR) and major pathological response (MPR) was 13 (31.7%) and 18 (43.9%), respectively. The incidence of microvascular invasion (MVI) was 4.9% in neoadjuvant therapy patients, compared with 64.9% before propensity score matching (PSM) and 60.9% after PSM for surgery alone patients. Neoadjuvant therapy patients had a significant better prognosis than surgery alone patients (recurrence-free survival p = 0.041, overall survival p = 0.006). Conclusions: Our preliminary results suggest the neoadjuvant D-TACE and tislelizumab therapy is safe and benefit to the pathological results and prognosis for patients with resectable or borderline resectable HCC.

目的 对比分析超声造影参数与糖类抗原125(CA125)、癌胚抗原(CEA)评估宫颈癌新辅助化疗疗效的价值.方法 选取我院行新辅助化疗的宫颈癌患者86例,根据治疗效果分为有效组(69例)和无效组(17例),比较两组化疗前后超声造影参数[上升时间(RT)、峰值强度(PI)、平均通过时间(MTT)、达峰时间(TP)]及CA125、CEA的差异.绘制受试者工作特征(ROC)曲线分析超声造影参数及CA125、CEA评估宫颈癌新辅助化疗疗效的诊断效能.结果 86例宫颈癌患者均行新辅助化疗,总有效率为80.23%.宫颈癌患者化疗后RT、PI、CA125、CEA均低于化疗前,MTT、TP均高于化疗前,差异均有统计学意义(均P<0.05).化疗前,有效组RT、PI、CA125、CEA均低于无效组,MTT、TP均高于无效组,差异均有统计学意义(均P<0.05);化疗后,有效组RT、PI、CA125、CEA均低于无效组,MTT、TP均高于无效组,差异均有统计学意义(均P<0.05).有效组化疗前后各超声造影参数及CA125、CEA比较差异均有统计学意义(均P<0.05).ROC曲线分析显示,RT、PI、MTT、TP、超声造影综合参数(RT、PI、MTT、TP联合)、CA125、CEA评估宫颈癌新辅助化疗疗效的曲线下面积分别为0.883、0.855、0.813、0.808、0.966、0.746、0.800,超声造影综合参数与CA125、CEA的曲线下面积比较差异均有统计学意义(Z=2.548、2.311,P=0.011、0.021).结论 超声造影参数评估宫颈癌新辅助化疗疗效的价值较CA125、CEA更佳,能为优化宫颈癌个体治疗方案提供参考.

OBJECTIVE:Microvascular invasion (MVI) is an independent risk factor for the early recurrence and poor survival of hepatocellular carcinoma (HCC). This study aims to investigate the potential clinical value of dynamic contrast-enhanced ultrasound (DCE-ultrasound)-Sonazoid in pre-operatively assessing MVI in HCC. METHODS AND MATERIALS:This single centre prospective study included 140 patients with histopathologically confirmed single HCC lesions. Patients were classified according to the post-operative pathological information presence of MVI: MVI+ group (n = 32) and MVI- group (n = 108). All patients underwent DCE-ultrasound within 1 week before surgery. The quantitative perfusion parameters of HCC lesions, margins of HCC lesions, and distal liver parenchyma were obtained and analyzed. RESULTS:Clinicopathological (serum alpha-fetoprotein, Des-gamma-carboxyprothrombin, and pathological grade) and grayscale imaging features (tumor size) were significantly different between the MVI+ and MVI- groups (p < 0.05). Further quantitative analysis showed that when comparing the MVI+ and MVI- groups, half-decrease time and wash-out rate of HCC lesions and peak enhancement in the arterial phase of difference between the margin area of HCC and distal liver parenchyma were significantly different (p = 0.045, p = 0.035, and p = 0.023, respectively). Combining the above three quantitative parameters, the accuracy, sensitivity, specificity, positive-predictive value, and negative-predictive value were 69.3% (97/140), 37.8% (17/45), 84.3% (80/95), 53.1% (17/32), 74.1% (80/108), respectively. CONCLUSION:DCE-ultrasound with quantitative perfusion analysis has the potential to predict MVI in HCC lesions. ADVANCES IN KNOWLEDGE:DCE-ultrasound with quantitative perfusion analysis has the potential to predict MVI in HCC lesions.

Objective: To investigate the contrast-enhanced ultrasound（CEUS） manifestations of cirrhosis primary hepatocellular carcinoma（PHC） diameter ＜1 cm and its correlation with alpha-L-fucosidase（AFU）, alpha-fetoprotein-L3（AFP-L3）, glypican-3（GPC3）,tumor specific growth factor（TSGF） and golgi protein 73（GP73） levels. Methods: 44 patients with cirrhosis PHC diameter ＜1 cm treated at Xiangyang Hospital of traditional Chinese medicine, Hubei Province, from January 2018 to August 2022 were selected, According to the postoperative pathological results, they were divided into high differentiation group, middle differentiation group and low differentiation group. CEUS and serum erum AFU, AFP-L3, GPC3, TSGF and GP73 levels were tested in all patients before operation. CEUS manifestations, quantitative time-intensity curve（TIC） analysis, and serum AFU, AFP-L3, GPC3, TSGF and GP73 levels were compared among the three groups. Spearman correlation was used to analyze the correlation between CEUS manifestations of cirrhosis PHC diameter ＜1cm and serum AFU, AFP-L3, GPC3, TSGF and GP73 levels. Results: The CEUS manifestations of the 44 patients with cirrhosis PHC diameter ＜1 cm were all single intrahepatic lesions, which were round or ceroid in shape with a clear lesion border and a visible acoustic halo around them. There was no significant difference in CEUS manifestations in arterial phase, portal phase and delayed phase in patients with different differentiation degrees of cirrhosis PHC diameter ＜1 cm（P＞0.05）. In terms of peak time, clearance time and peak acceleration time for high differentiation group, middle differentiation group and low differentiation group gradually decreased, and the differences were statistically significant（P＜0.05）. However, The rate of increase peak intensity of high differentiation group, middle differentiation group and low differentiation group gradually increased, and the differences were statistically significant（P＜0.05）. There was no significant difference in the enhancement time compared among the high differentiation group, middle differentiation group and low differentiation group（P＞0.05）. Serum AFU, AFP-L3, GPC3, TSGF and GP73 leves in the high differentiation group, middle differentiation group and low differentiation group were gradually increased, and the differences were statistically significant（P＜0.05）. Spearman correlation analysis showed that the peak time, clearance time and peak acceleration time were negatively correlated with serum AFU,AFP-L3, GPC3, TSGF, and GP73 levels（P＜0.05）, and the rate of increase peak intensity was positively correlated with serum AFU,AFP-L3, GPC3, TSGF, and GP73 levels（P＜0.05）. Conclusion: The CEUS manifestations of cirrhosis PHC diameter ＜1 cm were all single intrahepatic lesions, which were round or ceroid in shape with a clear lesion border and a visible acoustic halo around them. The CEUS manifestations are correlated with serum AFU, AFP-L3, GPC3, TSGF and GP73 levels, which can assist identify the different differentiation degrees of cirrhosis PHC diameter ＜1 cm.

近年来,我国公民逝世后器官捐献数量不断增加,但每年仍有大量的终末期肾病患者等待肾移植,供需不平衡仍是目前影响临床肾移植工作开展的主要问题之一.因此,准确评估供肾质量,充分利用扩大标准供肾具有十分重要的临床意义.超声造影因其安全、便携、实时、可量化等特点,已逐步应用于各类实体器官的检测,其在供肾质量评估方面也具有良好的应用前景.本文将从当前供肾评估方法的优势与局限性及超声造影应用于供肾评估的现状及优势进行综述,探讨超声造影在供肾质量评估中的应用前景,增加供肾评估的方法和准确性,为合理利用扩大标准供肾提供参考.

BACKGROUND:Hepatocellular carcinoma (HCC) is the most common primary liver malignancy.AIM:To predict early recurrence (ER) and overall survival (OS) in patients with HCC after radical resection using deep learning-based radiomics (DLR).METHODS:A total of 414 consecutive patients with HCC who underwent surgical resection with available preoperative grayscale and contrast-enhanced ultrasound images were enrolled. The clinical, DLR, and clinical + DLR models were then designed to predict ER and OS.RESULTS:The DLR model for predicting ER showed satisfactory clinical benefits [area under the curve (AUC)] = 0.819 and 0.568 in the training and testing cohorts, respectively), similar to the clinical model (AUC = 0.580 and 0.520 in the training and testing cohorts, respectively; P > 0.05). The C-index of the clinical + DLR model in the prediction of OS in the training and testing cohorts was 0.800 and 0.759, respectively. The clinical + DLR model and the DLR model outperformed the clinical model in the training and testing cohorts (P < 0.001 for all). We divided patients into four categories by dichotomizing predicted ER and OS. For patients in class 1 (high ER rate and low risk of OS), retreatment (microwave ablation) after recurrence was associated with improved survival (hazard ratio = 7.895, P = 0.005).CONCLUSION:Compared to the clinical model, the clinical + DLR model significantly improves the accuracy of predicting OS in HCC patients after radical resection.

目的 探讨超声造影及其定量分析对延迟相廓清的肝炎性病灶与肝细胞癌的鉴别诊断价值.方法 分析经手术或穿刺活检病理证实的38例肝炎性病灶患者(肝炎性病灶组,共38个病灶)和66例肝细胞癌患者(肝细胞癌组,66个病灶)的超声造影检查资料,分析并比较超声造影定量参数鉴别肝炎性病灶与肝细胞癌的截断值及其诊断效能.结果 肝炎性病灶组与肝细胞癌组在患者性别、临床症状、血清糖水平抗原125、甲胎蛋白(AFP)水平和乙型肝炎病毒感染史等方面比较,差异均有统计学意义(均P<0.05).肝炎性病灶组超声造影提示形态不规则和边界不清晰比例(23/38、30/38)均高于肝细胞癌组(10/66、4/66),差异均有统计学意义(均P<0.01);肝炎性病灶组表现为门脉相低增强30例、等增强8例,肝细胞癌组表现为门脉相低增强26例、等增强34例、高增强6例,两组比较差异有统计学意义(P<0.01).定量分析显示,肝炎性病灶组时间-强度曲线的曲线下面积(AUC)较肝细胞癌组增大,下降时间、平均通行时间均较肝细胞癌组缩短,差异均有统计学意义(均P<0.05).单变量分析结果显示,AUC>365.281、平均通行时间<22 s、下降时间<35.5 s鉴别肝炎性病灶与肝细胞癌的敏感性和特异性分别为100％和68.2％、92.4％和73.7％、100％和60.5％;Logistic回归多变量分析结果显示,AUC>365.281诊断肝炎性病灶为良性病变的符合率为100％.结论 超声造影为表现为延迟相廓清的肝炎性病灶与肝细胞癌的鉴别诊断提供了重要信息,定量分析可客观地显示病灶的血流灌注特征,具有较好的临床应用价值.