Background: Evaluation of renal blood perfusion is important for patients with hypertension. Contrast-enhanced ultrasound (CEUS) is a safe and non-invasive technique that allows semi-quantitative assessment of renal cortical perfusion. Using CEUS quantitative analysis, we aimed to employ the characteristics of renal cortical blood perfusion (RCBP) parameters in hypertension patients, providing objective evidence for quantifying the hemodynamic features of renal microcirculation. Methods: It was a single-center retrospective study that included data from 83 hypertensive patients without renal artery stenosis who underwent renal CEUS at the Department of Ultrasound Medicine, Beijing Hospital between October 2020 and June 2023. The study cohort comprised 45 males and 38 females. Data collected included patient height, weight, systolic and diastolic blood pressure, estimated glomerular filtration rate (eGFR), RCBP parameters, and other historical records. Through stratified analysis, the characteristics of RCBP parameters were analyzed for the left/right sides, different sexes, and elderly versus non-elderly individuals. Results: There were no statistically significant differences in all cortical blood flow perfusion parameters [peak intensity (PI); rise time (RT); mean transit time (MTT); area under the curve (AUC); wash-in area under the curve (iAUC); wash-out area under the curve (oAUC); time to peak (TTP); PI/MTT] between the right and left kidneys of the patients (P>0.05). The iAUC and TTP were greater in males than in females, with marginal statistical differences (both P<0.05). The MTT and TTP were greater in the elderly group than in the non-elderly group, whereas PI/MTT was greater in the non-elderly group, with marginal statistical differences (both P<0.05). The intraclass correlation coefficients (ICCs) and Bland-Altman plots demonstrated good inter-observer agreement for all cortical blood flow perfusion parameters, especially for time-related parameters. Conclusions: This study preliminarily investigated the characteristics of RCBP parameters in hypertensive patients, further validating good reproducibility of the quantitative analysis technique of contrast-enhanced ultrasound.

Background:Artificial intelligence-enhanced imaging techniques have demonstrated promising diagnostic potential for carotid plaques, a key cardiovascular and cerebrovascular risk factor. However, previous studies did not systematically synthesize their diagnostic accuracy. Objective:This study aimed to quantitatively explore the diagnostic efficacy of deep learning (DL) and radiomics for extracranial carotid plaques and establish a standardized framework for improving plaque detection. Methods:We searched the PubMed, Embase, Cochrane, Web of Science, and Institute of Electrical and Electronics Engineers databases to identify studies involving the use of radiomics or DL models to diagnose extracranial carotid artery plaques from inception up to September 24, 2025. The quality of the studies was determined using Quality Assessment of Diagnostic Accuracy Studies for Artificial Intelligence (QUADAS-AI). A meta-analysis was conducted using StataMP (version 17.0; StataCorp) with a bivariate mixed-effects model to calculate pooled sensitivity and specificity, generate summary receiver operating characteristic (SROC) curves, assess Cochran Q statistic and I²-based heterogeneity, and conduct subgroup analyses and regression analysis. Results:Among 40 studies comprising 17,246 patients, 34 integrated independent test sets or validation sets in the quantitative statistical analysis. Among them, 24 focused on DL models, 10 on machine learning models based on radiomics. The combined sensitivity, specificity, and area under the SROC curve were 0.88 (95% CI 0.85-0.91; P<.001; I2=93.58%), 0.89 (95% CI 0.85-0.92; P<.001; I2=91.38%), and 0.95 (95% CI 0.92-0.96), respectively. Compared with the machine learning models based on radiomics algorithms, DL models achieved comparable improvements in specificity and area under the SROC curve. It was observed that transfer learning and a large sample size enhanced the diagnostic performance of models. Models used to identify plaque stability and presence had similar diagnostic performances, both of which were more effective in identifying symptomatic plaque models. A total of 7 studies demonstrated that the models that combined clinical features exhibited comparable diagnostic capability to pure DL and radiomics models. Additionally, 7 studies performed external validation, obtaining lower diagnostic performance than in testing groups. Limited regression analysis failed to identify significant sources of heterogeneity, and the limited number of eligible studies restricted more comprehensive subgroup analyses. The high heterogeneity in the study results may be due to different scanning parameters, model architecture, image segmentation, and algorithms. Conclusions:Radiomics algorithms and DL models can effectively diagnose extracranial carotid plaque. However, there are concerns regarding irregularities in research design and the absence of multicenter studies and external validation. Future research should aim to reduce bias risk and enhance the generalizability and clinical orientation of the models.

PurposeUltrasound is the imaging modality of choice for preoperative diagnosis of lymph node metastasis (LNM) in thyroid cancer (TC), yet its efficacy remains suboptimal. As radiomics gains traction in tumor diagnosis, its integration with ultrasound for LNM differentiation in TC has emerged, but its diagnostic merit is debated. This study assesses the accuracy of ultrasound-integrated radiomics in preoperatively diagnosing LNM in TC.MethodsLiteratures were searched in PubMed, Embase, Cochrane, and Web of Science until July 11, 2023. Quality of the studies was assessed by the radiomics quality score (RQS). A meta-analysis was executed using a bivariate mixed effects model, with a subgroup analysis based on modeling variables (clinical features, radiomics features, or their combination).ResultsAmong 27 articles (16,410 TC patients, 6356 with LNM), the average RQS was 16.5 (SD:5.47). Sensitivity of the models based on clinical features, radiomics features, and radiomics features plus clinical features were 0.64, 0.76 and 0.69. Specificities were 0.77, 0.78 and 0.82. SROC values were 0.76, 0.84 and 0.81.ConclusionUltrasound-based radiomics effectively evaluates LNM in TC preoperatively. Adding clinical features does not notably enhance the model's performance. Some radiomics studies showed high bias, possibly due to the absence of standard application guidelines.

Background:Doppler ultrasound (DUS) is recommended in first-line imaging for the diagnosis of renal artery stenosis (RAS). However, the correct selection of Doppler direct or indirect parameters and their optimal thresholds remain controversial. This study explored simple ultrasound Doppler parameters to diagnose severe RAS (RAS ≥70%) in routine clinical practice. Methods:In this retrospective study, patients with clinically suspected renovascular hypertension who first underwent renal artery DUS and contrast-enhanced ultrasound (CEUS) and subsequent digital subtraction angiography (DSA) or computed tomography angiography (CTA) were consecutively included. Clinical characteristics and ultrasound Doppler hemodynamic parameters were collected, including peak systolic velocity (PSV), the ratio of the peak velocities in the renal artery and the aorta (RAR), the ratio of the peak velocities in the renal artery and the segmental artery (RSR), and the ratio of the peak velocities in the renal artery and the interlobar artery (RIR). All enrolled patients were divided into two groups based on the degree of diameter reduction: a severe stenosis group (diameter reduction ≥70%) and a non-severe stenosis group (diameter reduction <70%). Logistic regression analysis was performed to determine the independent predictors for severe stenosis. Receiver operating characteristic curves and areas under the curve were used to evaluate the diagnostic performance of the ultrasound Doppler parameters. Results:A total of 85 patients (106 renal arteries) with RAS were included in this study. The optimal thresholds of PSV in the main renal artery and the PSV ratios for diagnosing severe RAS obtained via receiver operating characteristic curves were 249.5 cm/s for PSV, 2.94 for RAR, 5.1 for RSR, and 7.5 for RIR. The areas under the curve of PSV and the ratios all exhibited good diagnostic efficiency (all >0.8). The combination of these four Doppler variables demonstrated a significant benefit to the overall diagnostic value compared with any factor alone [area under the curve (AUC) =0.962; 95% confidence interval (CI): 0.906-0.989; P<0.05]. The combination of PSV and RSR (AUC =0.925; 95% CI: 0.858-0.967) exhibited comparable diagnostic efficiency to the combination of four ultrasonographic variables (z statistic =1.882; P=0.06). Conclusions:This simple and accurate method to evaluate severe RAS based on the velocity obtained via basic DUS may facilitate the detection of severe RAS in the majority of medical institutions and provide a reliable basis for the selection of proper candidates for further angiography or revascularization.

目的 探讨阿尔茨海默病并发单纯疱疹病毒-1(HSV-1)感染患者外周血脑源性神经营养因子(BDNF),神经营养因子(NGF),血小板-内皮细胞黏附分子(CD31)水平.方法 回顾性分析2017年8月-2020年9月河南省濮阳市人民医院神经内科收治的86例阿尔茨海默病患者一般临床资料,将HSV-1感染者纳入感染组(n=65),将未出现HSV-1感染者纳入对照组(n=21),分析两组外周血BDNF、NGF、CD31与载脂蛋白E(ApoE)、tau、淀粉样β(Aβ)蛋白及氧化应激指标的相关性.结果 感染组BDNF、NGF、CD31均低于对照组(P＜0.05);感染组脑脊液中ApoE、tau、Aβ蛋白水平均高于对照组(P＜0.05);感染组SOD、MDA、NOS水平均高于对照组(P＜0.05);BDNF、NGF、CD31 与 ApoE、tau、Aβ 蛋白、SOD、MDA、NOS 呈负相关(P＜0.05);感染组 Cog-12 评分高于对照组,MMSE、ADL评分低于对照组(P＜0.05).结论 HSV感染促进AD发生、发展,会降低脑脊液中DNF、NGF、CD31水平,可能与改变AD患者ApoE、tau、Aβ蛋白,诱导氧化应激反应有关,且感染后患者认知功能、精神状态及生活质量均降低.

目的 探讨甲泼尼龙琥珀酸钠治疗急性期多发性硬化症的临床效果.方法 选取2019年3月至2021年3月我院收治的86例急性期多发性硬化症患者,根据红绿双色球法将其分为对照组和研究组,各43例.对照组开展地塞米松治疗,研究组开展甲泼尼龙琥珀酸钠治疗.比较两组的神经功能障碍程度、炎症因子、神经因子水平、不良反应发生情况及复发率.结果 治疗后,研究组的扩展残疾状态量表(EDSS)评分及基质金属蛋白酶-9(MMP-9)、干扰素-γ(INF-γ)水平低于对照组,白细胞介素-12p40(IL-12p40)水平高于对照组,差异具有统计学意义(P<0.05).治疗后,研究组的转化生长因子-β1(TGF-β1)、tau蛋白、S100蛋白水平高于对照组,差异具有统计学意义(P<0.05).研究组的不良反应总发生率及复发率低于对照组,差异具有统计学意义(P<0.05).结论 将甲泼尼龙琥珀酸钠用于急性期多发性硬化症患者中,可改善神经功能,减轻炎症反应,调节神经因子水平,减少不良反应的发生,降低复发率.

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.

目的 探讨改良脑皮质静脉显影评分(cortical vein opacification score,COVES)对大脑中动脉(middle cerebral artery,MCA)供血区引流皮质静脉充盈程度的评估.方法 回顾性连续纳入2019年12月-2021年9月于濮阳市人民医院进行了头颈CTA和CTP检查并显示病灶侧MCA狭窄的缺血性卒中患者.收集患者的临床资料、病灶侧和对侧的CTP脑灌注指标[达峰时间(time to peak,TTP)、脑血流量(cerebral blood flow,CBF)、脑血容量(cerebral blood volume,CBV)].基于C TA进行皮质静脉充盈程度的评估,单支静脉不显影为0分,部分显影为1分,完全显影为2分.COVES评分包括病灶侧大脑中浅静脉、蝶顶窦和下吻合静脉的总分;改良COVES评分包括病灶侧的上吻合静脉、下吻合静脉和蝶顶窦的总分.通过ROC曲线及AUC分析改良COVES和COVES预测脑灌注不同指标(TTP、CBF、CBV)异常的敏感度及特异度.比较改良COVES和COVES对脑灌注异常的预测价值.结果 共纳入55例缺血性卒中患者,年龄20～79岁,中位年龄58.5岁,男性34例(61.8％).COVES≤2分时,预测TTP异常的敏感度为50.0％,特异度为95.2％;预测CBF异常的敏感度为47.2％,特异度为94.7％;预测CBV异常的敏感度为45.5％,特异度为86.4％.改良COVES≤3分时,预测TTP异常的敏感度为70.6％,特异度为95.2％;预测CBF异常的敏感度为66.7％,特异度为94.7％;预测CBV异常的敏感度为66.7％,特异度为86.4％.改良COVES、COVES预测TTP异常的AUC分别为0.845、0.735,差异有统计学意义(P=0.039).结论 改良COVES评估脑皮质引流静脉充盈程度、脑灌注的价值优于COVES.

目的 探讨超声造影定量分析技术评估大动脉炎性肾动脉炎(TARA)患者肾皮质血流灌注情况的临床价值.方法 选取我院临床确诊为TARA患者21例(TARA组,42个肾)和排除肾脏、心脏或血管疾病的患者22例(对照组,44个肾),应用超声造影定量分析技术获取两组肾皮质血流灌注的时间-强度曲线及相关参数,包括曲线下面积(AUC)、上升支斜率(A)、峰值强度(PI)、达峰时间(TTP)和平均渡越时间(MTT),比较两组上述各参数的差异,并分析其与肾小球滤过率(GFR)间的相关性.结果 经CTA或DSA证实,TARA组42支肾动脉中26支存在管腔狭窄,归为患侧肾;16支无管腔狭窄,归为健侧肾.与对照组比较,TARA组患侧肾的AUC和A减小,PI降低,TTP和MTT增大,差异均有统计学意义(均P<0.05);TARA组健侧肾的A减小,TTP增大,差异均有统计学意义(均P<0.05).相关性分析显示,AUC、A、PI与GFR均呈正相关(r=0.755、0.743、0.695,均P<0.05),TTP、MTT与GFR均呈负相关(r=-0.707、-0.731,均P<0.05).结论 超声造影定量分析技术可准确评估TARA患者肾皮质血流灌注情况,其灌注参数与肾功能评价指标的相关性良好,具有一定的临床应用价值.

目的 探讨输血治疗联合放化疗在结直肠癌患者中的疗效及对肿瘤标志物和T淋巴细胞水平的影响.方法 回顾性分析2018年1月至2020年2月至云南省肿瘤医院接受治疗的结直肠癌患68例,结合患者病情,根据不同治疗方案均分为2组,对照组(n=34例)进行放化疗治疗,研究组(n=34例)进行输血治疗联合放化疗治疗.对比2组临床治疗效果、T淋巴细胞水平以及肿瘤标志物水平.结果 研究组临床治疗有效率高于对照组,差异有统计学意义(P＜0.05);干预前,2组T淋巴细胞因子水平对比,差异无统计学意义(P＞0.05),治疗后,研究组CD8+水平低于对照组,CD3+、CD4+、CD4+/CD8+水平均高于对照组,差异有统计学意义(P＜0.05);治疗前干预前,2组患者CA19-9、TK1、CEA、AFP水平比较,差异无统计学意义(P＞0.05),治疗后,研究组CA19-9、TK1、CEA、AFP水平均低于对照组,差异有统计学意义(P＜0.05).结论 结直肠癌患者施以输血治疗联合放化疗干预,可促进疗效提升,改善肿瘤标志物水平,提升机体免疫能力.

To evaluate whether contrast-enhanced ultrasound (CEUS) is an accurate, non-nephrotoxic diagnostic method and follow-up tool for use in patients with chronic kidney disease (CKD) and renal artery stenosis (RAS). In this prospective and monocentric study, we compared the sensitivity and specificity of CEUS for the diagnosis of RAS in CKD patients, using digital subtraction angiography (DSA) or computed tomographic angiography (CTA) as the gold standard methods. Further, the value of CEUS for distinguishing restenosis from other diseases was assessed. The ultrasound physicians conducted the examinations and served as the CEUS report readers who were blinded to the DSA or CTA results. Patients with RAS (n = 60) were enrolled. Average patient age was 64.4 ± 18.0 years and median estimated glomerular filtration rate was 66.1 mL/min/1.73 m2. CEUS was used to image 94 stenotic renal arteries and DSA- or CTA-verified stenosis was present in 96 renal arteries. The kappa value for CEUS was 0.776 (P < 0.001), with an accuracy of 92.5%, a sensitivity of 94.7%, and a specificity of 84.0%. The accuracy of CEUS was the same for the diagnosis of the CKD3b–5 group as for the CKD1–3a group (100% vs. 87.5%, P = 0.148). There was no difference in CEUS accuracy for the diagnosis of Takayasu RAS compared with atherosclerotic RAS (95.8% vs. 91.7%, P = 0.795). Twenty-nine CEUS examinations were performed to follow in-stent restenosis or progression of RAS, with a median follow-up time of 5.0 months (range 1.0–20.0). Two cases of in-stent restenosis in patients suffering from deteriorating kidney function and recurrent hypertension were examined by CEUS. CEUS examination is a credible alternative for diagnosing moderate and severe RAS in patients with CKD, and is a reliable tool for follow-up surveillance after renal artery revascularization treatment. It shouldn’t be thought as a color-coded duplex ultrasonography rescue in these patients.

Objective To collect blood samples of 64 RhD negative patients in our hospital for RHD genotyping and phenotype analysis (RhC/c/E/e), and analyze the distribution characteristics of different RHD genotypes. Methods The RHD gene of RhD negative patients was genotyped by fluorescence quantitative polymerase chain reaction (PCR) method. The Rh phenotype was identified by IgM anti-e, anti-c, anti-C and anti-E, respectively. Results Forty-two cases of RHD deletion were detected, dominated by ccee phenotype (88.1%); 9 of RHD1227A cases, dominated by Ccee phenotype(77.8%); 8 of RHD-CE(3-9)-D2 cases, dominated by Ccee phenotype (75%); 1 of RHD-CE(3-10)-D2 case with Ccee phenotype, 1 of RHD*711delC case; 1 of RHAG site invalid type were detected. The typing results could not be determined in 2 cases by PCR method. Conclusion RhD negative patients showed diversity in RHD genotype, dominated by RHD deletion, followed by RHD1227A, RHD-CE(2-9)-D2, RHD-CE(3-10)-D2, RHD*711delC and RHAG site deletions.

目的 探讨偏头痛患者脑白质损害情况及影响因素分析.方法 对114例偏头痛患者行磁共振成像、经食道超声心动图及经颅多普勒超声声学造影检查,明确患者脑白质损伤及右向左分流情况,采用单因素及多元Logistic回归分析探讨偏头痛患者脑白质损伤的影响因素.结果 本组114例患者,发生脑白质损伤35例(30.7％),无脑白质损伤79例(69.3％).脑白质损伤患者中存在单发病灶7例,多发病灶28例,共计72个病灶;脑白质损伤部位以额叶(36.1％)、顶叶(23.6％)为主.脑白质损伤患者头痛病程、头痛持续时间显著高于无损伤患者(P<0.05),其他资料比较差异无统计学意义(P>0.05).有无脑白质损伤患者右向左分流分级比较差异有统计学意义(P<0.01),其中脑白质损伤患者大量分流占比为50.0％,显著高于无脑白质损伤患者(P<0.01).回归分析显示,头痛病程、右向左分流分级是偏头痛患者脑白质损害的危险因素(OR=2.440、3.174,P<0.01).结论 部分偏头痛患者存在脑白质损害,主要病灶在脑额叶、顶叶;头痛病程及右向左分流分级是偏头痛患者脑白质损害的危险因素.

Objective This study aimed to observe the clinical imaging features of patients with severe atherosclerotic renal artery stenosis (ARAS) receiving stent implantation, and to evaluate the associations between baseline clinical and imaging factors and renal-function deterioration at a 1-year follow-up. Methods This study was a single-center retrospective cohort study. A total of 159 patients with unilateral severe ARAS who underwent stent implantation at Beijing Hospital between July 2017 and December 2020 were consecutively enrolled. According to the renal glomerular filtration rate (GFR), detected by radionuclide renal imaging at 1-year follow-up, all patients were divided into a poor-prognosis group (with a ≥30% decrease in renal GFR; n=32 cases) and a control group (127 cases). Clinical imaging data, including the renal cortical blood perfusion pre- and post-sent implantation, were analyzed. Univariate and multivariate logistic regression analysis was used to evaluate the associations between clinical and imaging factors and renal-function deterioration. Results Of the 159 patients enrolled, 83 (52.2%) were men, with an average age of (57.2±14.7) years. The patient age, rate of diabetes, and systolic blood and diastolic blood pressure in the poor-prognosis group were significantly higher than those in the control group (all P<0.05). Before stent treatment, patients in the poor-prognosis group, compared with the control group, had a significantly smaller area under the ascending curve (AUC1), area under the descending curve (AUC2), and peak intensity (PI), and a longer time to peak intensity (TTP) and mean transit time (MTT) (all P<0.05). After stent treatment, patients in the poor-prognosis group, compared with the control group, showed significantly smaller AUC1, AUC2, and PI, and longer MTT (all P<0.05). Multivariate logistic regression analysis indicated that age (OR=1.251, 95%CI: 1.113–1.406, P=0.0002), diabetes (OR=1.472, 95%CI: 1.110–1.952, P=0.007), systolic blood pressure (OR=1.339, 95%CI: 1.082–1.657, P=0.007), renal GFR (OR=2.025, 95%CI: 1.217–3.369, P=0.006), and AUC1 post-stent (OR=2.173, 95%CI: 1.148–4.113, P=0.017) were the factors associated with renal deterioration at the 1-year follow-up. Conclusions Patients with severe RAS with renal-function deterioration after stent implantation were older, and often had diabetes, hypertension, and impaired renal cortical perfusion. Age, diabetes, systolic blood pressure, renal GFR, and AUC1 after stent implantation were independent factors associated with short-term renal deterioration.

目的 探讨脑梗死后血管性认知障碍病人血清胱抑素C(CysC)、视黄醇结合蛋白(RBP)、颈动脉狭窄程度与认知功能的关系.方法 选取2016年9月—2018年8月我院确诊的脑梗死后血管性认知障碍病人160例,根据认知功能受损程度分为轻度组(49例)、中度组(58例)和重度组(53例).比较3组血清CysC、RBP、颈动脉狭窄程度、一般资料等;采用有序多分类Logistic回归分析法探讨各指标与血管性认知障碍病人认知功能受损程度的关系.结果 3组年龄、受教育时间、体质指数、性别、合并高血压、血脂异常、冠心病、吸烟、饮酒比较,差异均无统计学意义(P>0.05).随着认知功能受损程度加重,糖尿病、血清CysC、RBP水平均逐渐升高,差异有统计学意义(P<0.05).血管性认知障碍病人认知功能障碍程度与颈动脉狭窄程度呈正相关(P<0.05).有序多分类Logistic回归分析结果显示:血清CysC、RBP水平增高,颈动脉狭窄程度加重,入院时美国国立卫生研究院卒中量表(NIHSS)评分升高是血管性认知障碍病人认知功能障碍程度进一步加重的独立危险因素(P<0.05).结论 脑梗死后血管性认知障碍病人血清CysC、RBP水平增高,颈动脉狭窄程度加重,入院时NIHSS评分升高,可能加重认知功能障碍风险.

ObjectivesTo explore the role of Contrast-enhanced ultrasound (CEUS) in the evaluation of patients with suspected renal artery stenosis and analyze the causes of the misdiagnosis and missed diagnosis.MethodsThe data of 40 patients (80 renal arteries) diagnosed with RAS by CEUS in Beijing Hospital from September 2018 to October 2020 were compared with their digital subtraction angiography (DSA) results to analyze the causes underlying missed diagnosis and misdiagnosis of RAS by CEUS.Results1. Compared with the gold standard DSA results, the AUC of the ROC curve of CEUS in detecting normal renal artery and renal artery stenosis was 0.961, the sensitivity was 96.4%, the specificity was 95.8%, and the Kappa value of the consistency analysis was 0.912 (P < 0.01); 2. Compared with the gold standard DSA results, the ROC curve of CEUS in distinguishing renal artery stenosis ≥70% from <70% stenosis has an AUC of 0.916, a sensitivity of 90.9%, a specificity of 92.3%, and the Kappa value of the consistency analysis is 0.77 (P < 0.01); 3. CEUS missed two cases (one for mild stenosis and one for moderate stenosis), and the detection rate of renal artery stenosis was 97.5% (78/80); A total of 65 renal arteries diagnosed by CEUS were consistent with DSA, and the diagnostic accuracy of CEUS for the degree of stenosis was 81.25% (65/80); Among the 13 misdiagnosed renal arteries, 4 of them can be corrected to the same degree as DSA by the reference to hemodynamic index, and the diagnosis rate of the degree of renal artery stenosis by ultrasonography (combined with CEUS and hemodynamic indicators) can be improved to 86.25%.Conclusions1. CEUS can clearly show the renal arteries, and is consistent with DSA in distinguishing normal renal artery stenosis from renal artery stenosis, as well as renal artery stenosis ≥70% and <70% stenosis; 2. CEUS showed good performance in detecting normal renal artery and renal artery stenosis, and the missed diagnosis is concentrated on mild and moderate stenosis; 3. CEUS combined with hemodynamic indicators (Doppler ultrasound) can improve the accurate diagnosis rate of renal artery stenosis by ultrasonography; 4. The most important factor for the accurate diagnosis of renal artery stenosis by CEUS is the operator's standardized examination, which is not only related to the duration of the operator has been engaged in this inspection, but also related to whether the operator has received professional training in relevant aspects. These all indicate the necessity and importance of the standardized operation of renal artery contrast-enhanced ultrasound examination, and professional training should be given to operators.

Background This study aimed to observe the correlation between renal cortical blood perfusion (CBP) parameters and BP response in patients with severe renal artery stenosis (RAS) who underwent stenting. Methods This was a single-center retrospective cohort study. A total of 164 patients with unilateral severe RAS after successful percutaneous transluminal renal artery stenting in Beijing Hospital from October 2017 to December 2020 were included. According to the results of BP evaluated at 12 months, all patients were divided into the BP response group (n = 98) and BP nonresponse group (n = 66). The baseline clinical and imaging characteristics and follow-up data about 24 h ABPM and CBP were recorded and analyzed. Pearson correlation analysis was used to evaluate the relationship between CBP parameters and 24 h average SBP. Univariate and multivariate logistic regression analysis was used to evaluate the risk factors for BP response. Results Among 164 patients with severe RAS, there were 100 males (61.0%), aged 37–75 years, with an average of 56.8 ± 18.4 years, and average artery stenosis of 84.0 ± 12.5%. The BP nonresponse patients had a longer duration of hypertension, more current smoking subjects and diabetic patients, lower eGFR, increased number of hypertensive agents, and rate of insulin compared with the BP response group (P < 0.05). After PTRAS, patients in the BP response group were associated with significantly lower BP and improved CPB, characterized by increased levels of maximum intensity (IMAX), area under ascending curve (AUC1), area under the descending curve (AUC2), shortened rising time (RT), mean transit time (mTT), and prolonged time to peak intensity (TTP; P < 0.05). However, the BP nonresponse group was only associated with significantly reduced RT (P < 0.05) compared with baseline data. During an average follow-up of 11.5 ± 1.7 months, the BP response group was associated with significantly lower levels of SBP, DBP, 24 h average SBP, and 24 h average DBP compared with the nonresponse group (P < 0.05). Pearson correlation analysis showed that the the pre-operative CBP parameters, including IMAX (r = 0.317), RT (r = 0.249), AUC1 (r = 0.614), AUC2 (r = 0.558), and postoperative CBP parameters, including RT (r = 0.283), AUC1 (r = 0.659), and AUC2 (r = 0.674) were significantly positively correlated with the 24 h average SBP, while the postoperative TTP (r = −0.413) and mTT (r = −0.472) were negatively correlated with 24 h average SBP (P < 0.05). Multivariate Logistic regression analysis found that diabetes (OR = 1.294), NT-proBNP (OR = 1.395), number of antihypertensive agents (OR = 2.135), pre-operation IMAX (OR = 1.534), post-operation AUC2 (OR = 2.417), and baseline dDBP (OR = 2.038) were related factors for BP response (all P < 0.05). Conclusion Patients in the BP nonresponse group often have diabetes, a longer duration of hypertension, significantly reduced glomerular filtration rate, and heavier renal artery stenosis. CBP parameters are closely related to 24 h average SBP, and pre-operation IMAX and post-operation AUC2 are markers for a positive BP response.

Objective:To investigate the imaging characteristics on contrast-enhanced ultrasound(CEUS)of carotid plaque instability and their correlation with histopathological changes in elderly patients.Methods:Twenty-three patients undergone carotid endarterectomy(CEA)at the Department of Neurosurgery of Beijing Hospital from June 2018 to November 2020 were retrospectively enrolled, including 27 males and 5 females, aging from 60 to 87(68.1±6.3)years.They were diagnosed with moderate to severe carotid artery stenosis(50%-99%)based on digital subtraction angiography(DSA).Carotid artery CEUS was conducted before surgery, and HE staining and CD34 immunohistochemical staining were used to record histopathological scores and microvessel density(MVD)counts.Results:The mean pathological score and MVD count were 2.46±0.66 and 37.17±12.88 for 32 cases with hypoechoic patterns, 22.42±0.55 and 38.06±13.66 for 18 cases with mixed echo patterns, and 2.75±0.35 and 23.50±9.192 for 2 cases with strong echo patterns, respectively.CEUS grading was positively correlated with histopathology score and MVD count( r=0.53、0.76, all P<0.01). Conclusions:Low echo and mixed echo plaques are more unstable than strong echo plaques.CEUS can be used to comprehensively assess the vulnerability of atherosclerotic plaques and to decide the optimal surgical time for patients with carotid atherosclerotic plaque stenosis.

Abstract. Background:. This study aims to observe the dynamic changes of renal artery (RA) disease and cortical blood perfusion (CBP) evaluated by contrast-enhanced ultrasound (CEUS) after percutaneous transluminal renal artery stenting (PTRAS) in patients with severe atherosclerotic renal artery stenosis (ARAS) and to analyze the relationship between CBP and prognosis. Methods:. This was a single-center retrospective cohort study. A total of 98 patients with unilateral severe ARAS after successful PTRAS in Beijing Hospital from September 2017 to September 2020 were included. According to renal glomerular filtration rate (GFR) detected by radionuclide imaging at 12 months after PTRAS, all patients were divided into the poor prognosis group (n = 21, GFR decreased by ≥20% compared with baseline) and the control group (n = 77, GFR decreased by < 20% or improved compared with baseline). Renal artery stenosis was diagnosed by digital subtraction angiography, and renal CBP was evaluated by CEUS using TomTec Imaging Systems (Germany) before PTRAS, at 6 months and 12 months after discharge. The receiver operating characteristic (ROC) curve with area under the curve (AUC) was used to analyze the predictive value of CBP parameters, including area under ascending curve (AUC1), area under the descending curve (AUC2), rising time (RT), time to peak intensity (TTP), maximum intensity (IMAX), and mean transit time (MTT) for poor prognosis. Results:. Among the 98 patients, there were 52 males (53.1%), aged 55–74 years old, with an average age of 62.1 ± 8.7 years, and an average artery stenosis of 82.3 ± 12.9%. The poor prognosis group was associated with significantly increased incidence of diabetes (76.2% vs. 41.6%), and lower levels of GFR of the stenotic kidney (21.8 mL/min vs. 25.0 mL/min) and total GFR (57.6 mL/min vs. 63.7 mL/min) (all P < 0.05), compared with the control group (P < 0.05). In addition, the rate of RA restenosis was significantly higher in the poor prognosis group than in the control group (9.5% vs. 0, χ2 = 9.462, P = 0.002). Compared with the control group, the poor prognosis group was associated with significantly decreased baseline AUC1 and AUC2, and extended duration of TTP and MTT (P < 0.05). At 6 months and 12 months of follow-up, patients in the control group were associated with markedly increased AUC1, AUC2, and IMAX, and shorter duration of RT and MTT (P < 0.05). The ROC curve showed that the predictive values of AUC1, AUC2, RT, TTP, IMAX, and MTT for poor prognosis were 0.812 (95% CI: 0.698–0.945), 0.752 (95% CI: 0.591–0.957), 0.724 (95% CI: 0.569–0.961), 0.720 (95% CI: 0.522–0.993), 0.693 (95% CI: 0.507–0.947), and 0.786 (95% CI: 0.631–0.979), respectively. Conclusions:. Preoperative renal CBP in severe ARAS patients with poor prognosis is significantly reduced, and does not show significant improvement after stent treatment over the first year of follow-up. The parameter AUC1 may be a good predictor for renal dysfunction after PTRAS in severe ARAS patients. Trial Registration:. ChiCTR.org.cn, ChiCTR1800016252.