Estimation of the fractional flow reserve (FFR) pullback curve from invasive coronary imaging is important for the intraoperative guidance of coronary intervention. Machine/deep learning has been proven effective in FFR pullback curve estimation. However, the existing methods suffer from inadequate incorporation of intrinsic geometry associations and physics knowledge. In this paper, we propose a constraint-aware learning framework to improve the estimation of the FFR pullback curve from invasive coronary imaging. It incorporates both geometrical and physical constraints to approximate the relationships between the geometric structure and FFR values along the coronary artery centerline. Our method also leverages the power of synthetic data in model training to reduce the collection costs of clinical data. Moreover, to bridge the domain gap between synthetic and real data distributions when testing on real-world imaging data, we also employ a diffusion-driven test-time data adaptation method that preserves the knowledge learned in synthetic data. Specifically, this method learns a diffusion model of the synthetic data distribution and then projects real data to the synthetic data distribution at test time. Extensive experimental studies on a synthetic dataset and a real-world dataset of 382 patients covering three imaging modalities have shown the better performance of our method for FFR estimation of stenotic coronary arteries, compared with other machine/deep learning-based FFR estimation models and computational fluid dynamics-based model. The results also provide high agreement and correlation between the FFR predictions of our method and the invasively measured FFR values. The plausibility of FFR predictions along the coronary artery centerline is also validated.

Several studies have demonstrated the difficulties in distinguishing malignant lesions of the breast from benign lesions owing to overlapping morphological features on ultrasound. Consequently, we aimed to develop a nomogram based on shear wave elastography (SWE), Angio Planewave Ultrasensitive imaging (Angio PLUS (AP)), and conventional ultrasound imaging biomarkers to predict malignancy in patients with breast lesions. This prospective study included 117 female patients with suspicious lesions of the breast. Features of lesions were extracted from SWE, AP, and conventional ultrasound images. The least absolute shrinkage and selection operator (Lasso) algorithms were used to select breast cancer-related imaging biomarkers, and a nomogram was developed based on six of the 16 imaging biomarkers. This model exhibited good discrimination (area under the receiver operating characteristic curve (AUC): 0.969; 95% confidence interval (CI): 0.928, 0.989) between malignant and benign breast lesions. Moreover, the nomogram also showed demonstrated good calibration and clinical usefulness. In conclusion, our nomogram can be a potentially useful tool for individually-tailored diagnosis of breast tumors in clinical practice.

BACKGROUND:Pregnancy is known to be a risk factor for venous thromboembolism (VTE). We report the case of a pregnant patient with difficult to diagnose iliac vein thrombosis, establishing a definite diagnosis by clues of great saphenous vein reflux.CASE PRESENTATION:A 37-year-old G1P0 woman at 35 weeks of assisted twin gestation presented with a complaint of persistent left lower limb edema and tenderness. A vascular ultrasound was used to examine the bilateral lower limb. Doppler of left lower extremity revealed continuous great saphenous vein reflux. Right saphenofemoral veins demonstrated venous stasis and no reflux. Unilateral continuous great saphenous vein reflux suggested left iliac veins obstruction or extrinsic compression. Anterograde venography showed a completely occlusive filling defect of the left external iliac vein, which is the definitive diagnosis of acute deep venous thrombosis. The patient underwent a cesarean delivery following inferior vena cava filter (IVCF) placement, and no signs of deep venous thrombosis (DVT) or pulmonary embolism (PE) were reported after delivery.CONCLUSION:In pregnant women with suspected deep vein thrombosis, it is imperative to assess the presence of unilateral continuous great saphenous vein reflux.

INTRODUCTION:At present, early detection of the potential risk of atherosclerosis and prevention is of great significance to reduce the occurrence of stroke. AIM:This study aims to explore the value of combining the wall shear stress measured by ultrasound vector flow imaging technique and sound touch elastography of common carotid artery in normal adults using the Mindray Resona 7 ultrasound system. METHODS:Forty volunteers (mean age 39.5 y, 23 females, 17 males) were divided into four groups according to their age. All volunteers underwent ultrasound carotid artery examination, and the values of wall shear stress and elasticity on the posterior wall of the common carotid artery were measured using advanced imaging functions, vector flow imaging technique, and sound touch elastography. RESULTS:Different cut-off values of wall shear stress were used to investigate the significance between two groups with corresponding sound touch elastography values. It can be seen that the statistical difference could be found when the mean wall shear stress was larger than 1.5 Pa approximately (statistical significance was defined when P < 0.05), and the sound touch elastography value was positively correlated with the wall shear stress value. CONCLUSION:This study reveals that the combination of wall shear stress and sound touch elastography is an effective and feasible method for assessing carotid artery health. When the mean wall shear stress value is over 1.5 Pa, the corresponding sound touch elastography value increases significantly. The risk of atherosclerosis increases with the stiffness of blood vessel walls.

BACKGROUND:Carotid artery pseudoaneurysm (PSA) is infrequently encountered in clinical settings. Internal carotid artery (ICA) PSA complicated with ischemic stroke is rare. PSAs are typically caused by iatrogenic injury, trauma, or infection. The underlying mechanisms of spontaneous PSA formation are not well characterized. We report a healthy young man who presented with stroke as a complication of spontaneous PSA of the left ICA.CASE SUMMARY:A 30-year-old man working as a ceiling decoration worker was hospitalized due to sudden-onset speech disorder and right lower extremity weakness. Medical history was unremarkable. Brain computed tomography revealed ischemic stroke. Digital subtraction angiography showed a left ICA PSA with mild stenosis. The patient was conservatively managed with oral anticoagulation and antiplatelet therapy. He recovered well and was discharged. The patient was in good condition during follow-up.CONCLUSION:The occupational history of patient should be taken into consideration while evaluating the etiology of spontaneous ICA PSA in young people with stroke.

Background To assess the stiffness of benign breast masses in ultrasound images with posterior acoustic shadowing (PAS) and malignant lesions, and explore the significance of differential diagnosis using ultrasound real time shear wave elastography. Material and methods All 117 mammary masses (98 patients) with PAS were assessed by using routine ultrasound examination, and elastic modulus values were obtained with the real time shear wave elastography mode. All breast lesions were confirmed by surgery or biopsy. The significance of differences in ultrasound elastography values between breast benign and malignant masses with posterior acoustic shadowing was assessed, and the ROC curves of elasticity modulus values were analyzed. Results Among the 117 masses, 72 were benign and 45 were malignant. The two types of breast masses showed significant differences in size, margin, internal echo, calcification, and blood flow characteristics ( P < 0.05), although the difference in orientation was not significant ( P > 0.05). Emean , Emax and Esd obtained with real time shear wave elastography showed statistically significant differences between benign masses with posterior acoustic shadowing and breast cancer ( P < 0.05), while Emin showed no significant difference between them ( P = 0.633). Ultrasound real time shear wave elastography showed higher sensitivity and specificity than conventional ultrasound. Conclusions Benign and malignant breast masses with PAS show different ultrasound manifestations. Real time shear wave elastography can facilitate the differential diagnosis and treatment planning for these breast masses.

患者,男,25岁.无明显诱因出现右侧手臂麻木,连续伏案工作1d后手麻加重,并出现右臂胀痛,手指发黑,既往体健,无不良嗜好,遂来我院就诊.急诊超声检查发现右锁骨下静脉及右上肢静脉异常低回声充填,彩色多普勒超声检查未见血流信号,考虑急性静脉血栓形成.

目的 探讨容积导航经直肠超声(TRUS)与多参数磁共振成像(MP-MRI)实时融合状态下TRUS图像可疑区域与前列腺癌病灶风险的关系.方法 回顾性分析114例经容积导航TRUS与MP-MRI影像融合引导下靶向穿刺病理检查证实为前列腺癌患者的资料,根据影像融合状态下TRUS图像是否存在可疑区域分为阳性组和阴性组,比较两组前列腺成像报告和数据系统(PI-RADS)评分及病理Gleason评分的差异.结果 114例患者共114个病灶,阳性组70个,阴性组44个.PI-RADS评分为2、3、4、5分的前列腺癌病灶占比分别为5.3％、15.8％、37.7％、41.2％.在PI-RADS 3分及以下病灶中,有25.0％超声表现为阳性;PI-RADS 4、5分病灶中,有71.1％超声表现为阳性;PI-RADS 5分病灶中,有89.4％超声表现为阳性,两组不同PI-RADS评分分布比较差异有统计学意义(P<0.05).阳性组中77.1％的前列腺癌病灶病理Gleason评分在7(4+3)分及以上;阴性组中36.3％的前列腺癌病灶病理Gleason评分在7(4+3)分及以上,二者比较差异有统计学意义(P<0.05).结论 应用容积导航TRUS与MP-MRI影像融合引导下靶向穿刺活检可有效提高前列腺癌病灶诊断率.PI-RADS 4、5分前列腺癌病灶的TRUS图像更容易存在可疑区域,且该类病灶中大多为高危性前列腺癌,提示存在更大的高危前列腺癌风险.

The success of gene therapy depends largely on the development of gene vectors and effective gene delivery systems. It has been demonstrated that cationic microbubbles can be loaded with negatively charged plasmid DNA and thus improve gene transfection efficiency. In this study, we developed dual-targeting cationic microbubbles conjugated with iRGD peptides(Cyclo(Cys-Arg-Gly-Asp-Lys-Gly-Pro-Asp-Cys)) and CCR2 (chemokine (C-C motif) receptor 2) antibodies (MBiRGD/CCR2) for ultrasound molecular imaging and targeted tumor gene therapy. The ultrasound molecular imaging experiments showed that there were significantly enhanced ultrasound molecular imaging signals in the tumor that received MBiRGD/CCR2, compared with those that received MBiRGD, MBCCR2, or MBcontrol. As a therapy plasmid, pGPU6/GFP/Neo-shAKT2, carrying an expression cassette for the human AKT2 RNA interference sequence, was used. Our results demonstrated that MBiRGD/CCR2 had a significantly higher gene transfection efficiency than MBiRGD, MBCCR2, or MBcontrol under ultrasound irradiation, resulting in much lower AKT2 protein expression and stronger tumor growth inhibition effects in vivo and in vitro. In conclusion, our study demonstrated a novel gene delivery system via MBiRGD/CCR2 for ultrasound molecular-imaging-guided gene therapy of breast cancer.

The present study compared the effects of ultrasonic irradiation and SonoVue microbubbles (US) or Lipofectamine 3000 on the transfection of small interfering RNA for PRR11 (siPRR11) and Proline-rich protein 11 (PRR11) overexpression plasmid into breast cancer cells. SiPRR11 and PRR11 overexpression plasmid were transfected into breast cancer MCF7 cells mediated by US and Lipofectamine 3000. PRR11 expressions in breast cancer and normal tissues were determined using Gene Expression Profiling Interactive Analysis (GEPIA). The viability, proliferation, migration, invasion and apoptosis of breast cancer cells were respectively measured by MTT assay, clone formation assay, scratch wound-healing assay, Transwell assay and flow cytometry. PRR11 and epithelial-to-mesenchymal transition (EMT)-related and apoptosis-related (B-cell lymphoma 2, Bcl-2; Bcl-2-associated protein X, Bax) proteins' expressions were detected by quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot as appropriate. As ultrasonic intensity increased, the viability of MCF7 cells was decreased. Results from GEPIA suggested that PRR11 was up-regulated in breast cancer. Silencing PRR11 mediated by US showed a higher efficiency than by Lipofectamine 3000. SiPRR11 transfected by Lipofectamine 3000 suppressed cells growth and metastasis, while promoted cell apoptosis. Moreover, E-cadherin (E-cad) and Bax expressions were high but N-cadherin (N-cad), Snail and Bcl-2 expressions were low. However, overexpressed PRR11 caused the opposite effects. More importantly, transfection of siPRR11 and PRR11 overexpression plasmid using US had a higher efficacy than using Lipofectamine 3000. US transfection of PRR11 siRNA showed better effects on inhibiting breast cancer progression. The current findings contribute to a novel treatment for breast cancer.

Objective:To explore the characters of CDU imaging anatomy and results of clinical application of perforating branch of median cubital vein, and to find the evidence of utilizing perforating vein to establish high level hemodialysis access.Methods:From November, 2016 to October, 2019, 150 median cubital veins in 75 persons were observed by CDU. And the inner diameter and length of the perforating branch were measured Perforating branches of median cubital vein were categorized with ultrasonic imaging anatomy. Thirty-eight chronic kidney failure patients who can not build forearm fistulas were operated by end-to-side anastomosis between perforating branch vein and brachial artery to build hemodialysis access. The blood flow of fisultas was measured,the mature period of fisultas was recorded. The length of available vessels of fisultas was measured and the long-term utilization rate of fisultas was counted.Results:Perforating branch of median cubital vein was always located in a little below elbow near brachial artery, the rate of occurrence was 94.0%. It was sent out at intersection of veins. There were 4 types of perforating vein in image-anatomy. There was no significant difference in vessel length and vessel inner diameter between different types ( P>0.05) ; All the 38 patients with mature fistulas could meet the needs of hemodialysis. The available vascular length of fistulas in type I and type II patients was better than that in type III ( P<0.01), and the long-term utilization rates of fistulas in type I, type II and type III were 84.6%, 85.7% and 72.7%, respectively. There was no significant difference in blood flow and mature period between different types ( P>0.05) . Conclusion:It is most safe and reliable to use the type I and type II of perforating branch of median cubital vein to make the high level fistulas , which can provide a safe and efficient hemodialysis access for the patients with forearm vascular drain, elderly diabetes patients and difficult fistulas with repeatedly thrombosis.

Objective:To explore the differential diagnostic value of ultrasonic elastography for breast nodules with acoustic attenuation.Methods:A total of 105 cases with breast nodules with posterior echo attenuation from June 2017 to October 2019 in Shenzhen People′s Hospital were enrolled. Routine ultrasound examination and elastography were performed and maximum of elastography(Emax), mean of elastography value(Emean), minimum of elastography value(Emin) and strain ratio of fat/strain ratio of nodules(B/A) were recorded. With the pathological results as the diagnosed gold standard, elastic parameters different between benign and malignant breast nodules with posterior echo attenuation were compared. And the Emax value of elastic imaging was analyzed by the ROC curve.Results:There were 65 cases of benign nodules and 40 cases of malignancy. The difference of ultrasound E imaging were statistically significant for judging benign and malignant breast nodules with acoustic attenuation( P<0.05). When Emax 95 kPa was set as the cut-off value for the differential diagnosis of benign and malignat breast nodules, the area under the ROC curve was 0.817, and the sensitivity was 88% and the specificity was 72%. Conclusions:Ultrasonic elastrography is of great value for differential diagnosis of benign and malignant breast nodules with acoustic attenuation, and it is important for the decision making of clinical treatment plan.

Cardiovascular diseases are the biggest threat to human being's health all over the world, and carotid atherosclerotic plaque is the leading cause of ischemic cardiovascular diseases. To determine the location and shape of the plaque, it is of great significance to detect the intima-media (IM). In this paper, a new IM detection method based on convolution neural network (IMD-CNN) is proposed for the detection of IM of blood vessels in longitudinal ultrasonic images. In IMD-CNN, firstly the region of interest (ROI) is automatically extracted by morphological processing, then the patch-wise training data are constructed, and finally a simple CNN is trained to detect the IM. The experimental results obtained on 23 images show that the test accuracy of IMD-CNN is over 86% and the performance of IMD-CNN is also visually proved to be effective.

目的 本研究主要探讨经直肠实时弹性成像(TRTE)引导靶向穿刺在前列腺病变中的应用价值.方法 对符合纳入标准的112例可疑前列腺癌患者进行经直肠前列腺超声检查,在TRTE引导下对可疑病灶进行2针靶向穿刺活检及超声引导下传统12针系统穿刺活检.分析TRTE对前列腺良恶性病变诊断效能及比较TRTE引导下靶向穿刺与系统穿刺诊断的准确性.结果 本研究112例患者中,TRTE共诊断前列腺癌54例,良性病变58例,最终病理确诊前列腺癌42例,良性病变70例,诊断的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为88.1％、75.7％、80.3％、0.68、0.91.TRTE引导靶向穿刺诊断前列腺癌针数84针,阳性率37.5％(84/224),系统穿刺诊断前列腺癌针数313针,阳性率23.3％(313/1344),二者具有统计学差异,χ2=4.08,P<0.05.同时行靶向加系统穿刺诊断前列腺癌针数397针,阳性率25.3％(397/1568).结论 TRTE在前列腺病变诊断中具有较高的灵敏度、特异度、准确度.利用TRTE引导靶向穿刺诊断Pca拥有比系统穿刺更高的准确性,但就目前来讲TRTE引导靶向穿刺尚无法完全取代系统穿刺法,而两者相结合是减少前列腺癌穿刺假阴性率的主要方案.

Objective To explore the diagnostic value of high frequency three-dimensional (3D) ultrasound in breast masses.Methods Seventy-seven cases of breast lesions were selected by 2D ultrasonic scan,and all the cases had been examined by 3D ultrasound and accepted surgical treatment in Shenzhen People's Hospital.With pathological results as the gold standard for diagnosis,the convergence sign in diagnosis of breast masses was used as malignant standard for 3D ultrasound coronal plane.The sensitivity and specificity were analyzed of 3D ultrasound in the diagnosis of benign and malignant breast tumors.Results A total of 77 cases of breast lesions included 46 malignant and 31 benign.3D ultrasound convergence sign was used to judge the benign and malignant breast tumors with statistical significance (x2 =26.790,P ＜ 0.01).The diagnostic sensitivity and specificity were 69.7％,and 90.3％,respectively.Conclusions High frequency 3D ultrasonography has certain value in differential diagnosis of benign and malignant breast tumors,and has important significance for the formulation of treatment plan.

Objective To measure the gray-scale median(GSM)and total plaque volume(TPV)in carotid plaque by three-dimensional ultrasonography,and to analyze the correlation between GSM,TPV,the ratio Q and stroke.Methods A total of 107 patients with carotid plaque were randomly selected,based on cranial CT and MRI findings,66 cases of carotid plaque and stroke occurred in the same side were identified as stroke group(group A),and 41 cases of carotid plaque and stroke occurred in the opposite side were identified as non-stroke group(group B). Three-dimensional ultrasonography was performed on both groups,and GSM and TPV were obtained by QLAB-VPQ software,the ratio Q was calculated to analyze their correlation with stroke.ROC curve was drawn to obtain the area under curve and 95% CI by using GSM,TPV and ratio Q in diagnosis of stroke. Results The Wilcoxon rank-sum test of GSM,TPV and ratio Q between group A and group B were performed,there were significant difference(Z=-1.644,-4.515,-4.857,P=0.032,0.043,0.000). Unconditional logistic regression analysis showed that OR of GSM was calculated as 1.078(1.024~1.135),OR of TPV was calculated as 1.037(1.019~1.056),OR of ratio Q was calculated as 1.015(1.007~1.024).ROC curve showed that AUC of GSM in diagnosis of stroke was 0.812,95%CI 0.729~0.894 (P=0.000),AUC of TPV in diagnosis of stroke was 0.806,95%CI 0.729~0.891(P=0.000),AUC of ratio Q in diagnosis of stroke was 0.821,95%CI 0.743~0.899(P=0.000).Conclusion GSM,TPV and ratio Q has a certain correlation with the occurrence of stoke,ratio Q with the highest diagnostic value.

目的 探讨常规超声结合弹性成像、钼靶X射线多模态影像学对三阴性乳腺癌的诊断价值.方法 回顾性分析63例三阴性乳腺癌的常规超声、弹性成像及钼靶X射线表现,比较超声结合弹性成像和钼靶X射线诊断三阴性乳腺癌的临床价值,分析两者联合诊断三阴性乳腺癌的准确性.结果 超声结合弹性成像、钼靶X射线及两者联合对三阴性乳腺癌的诊断符合率分别为84.1％、77.80％ 和92.1％.乳腺超声结合弹性成像与钼钯X射线表现比较,超声对三阴性乳腺癌的诊断符合率高,两种影像检查相结合时对三阴性乳腺癌的诊断符合率高于单独使用超声及钼钯X射线时.结论 多模态影像有利于提高三阴性乳腺癌的诊断率.

To evaluate the value of ultrasonography in the diagnosis of anterior cruciate ligament injury (ACL injury) by conducting a systematic review and meta-analysis. A literature search was carried out in the Cochrane Library, Embase, Pubmed databases and included studies prior to April 2017. Based on inclusion and exclusion criteria, studies evaluating ultrasound to diagnose ACL injury were selected. MRI, arthroscopy and clinical-follow were considered the reference standards. The diagnostic accuracy of ultrasound was assessed using a combination of sensitivity, specificity, likelihood ratio (LR), post-test probability, diagnostic odds ratio (DOR) and by summarizing the area under the receiver operating characteristic (SROC) curve. A total of 4 studies involving 246 patients were eventually included in the analysis. In these four studies, the combined sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, post-test probability and DOR were 90.0% (95% CI: 77-96), 97% (95% CI: 90-99), 31.08 (95% CI: 8.75-110.41), 0.11 (95% CI: 0.05-0.24), 89% (3%) and 288.81 (95% CI: 78.51-1062.48), respectively. The area under the SROC curve was 0.98 (95% CI: 0.97-0.99). Our meta-analysis showed that ultrasound can play an important role in the diagnosis of ACL injury. Because of its high sensitivity, high specificity and high diagnostic ability, ultrasound should be a part of the standard diagnostic work-up of an ACL injury.

1 病例介绍 患者,男,73岁,无明显诱因出现左下肢无力、行走拖曳、持续无缓解半月余入院.入院查体:BP:150/90 mmHg(1mHg=0.133 Kpa),神清,无头痛头晕,无恶心呕吐;左下肢肌力Ⅳ级,右下肢肌力Ⅴ级;左侧肢体腱反射(++),右侧肢体腱反射(+++);左侧巴宾斯基征(-),右侧巴宾斯基征(+).既往史:患高血压10余年,血压最高可达215/80 mmHg,患2型糖尿病6余年,脑梗死病史4余年,短暂性脑缺血半年,冠心病支架术后1年.

Carotid vulnerable plaques and the incidence of stroke are closely related.At present,ultrasound is one of the effective methods to detect carotid plaques.The application progresses of ultrasound in assessing vulnerable plaques are reviewed in this article.