BACKGROUND:Identifying molecular subtypes of breast cancer (BC) is of great significance in selecting optimal treatment strategy. Different molecular subtypes of BC have various vascular distribution characteristics. Contrast-enhanced ultrasound (CEUS) can dynamically display the microcirculation of tumor. This study intends to explore the conventional ultrasound and CEUS characteristics of different molecular subtypes of BC.METHODS:During this prospective study, 86 patients with BC who were divided into Luminal A (LA), Luminal B (LB), HER2 over-expression (H2), and triple-negative (TN). The CEUS qualitative and quantitative characteristics of BC with different molecular subtypes was explored, as well as the conventional ultrasound features. In addition, the diagnostic efficiency of CEUS quantitative parameters in differentiating molecular subtypes of BC was analyzed.RESULTS:Our study found that the Adler grade differed significantly among 4 molecular subtypes (P < .05). The enhancement speed, enhancement degree and size after enhancement of 4 molecular subtypes were statistically different (P < .05). The wash in slope (WIS), peak intensity (PI), and wash-in area under the curve (WiAUC) differed significantly among 4 subtypes (P < .05). The diagnostic efficiency of PI was better for detecting LA and H2 subtype with the areas under the receiver operating characteristic curve was 0.778 and 0.734, respectively.CONCLUSION:Different molecular subtypes of BC have different CEUS and conventional ultrasound characteristics. CEUS can provide valuable imaging basis for precise clinical diagnosis and individualized therapy of BC with different molecular subtypes.

Objective To establish a machine learning diagnosis model for early liver tumors based on contrast-enhanced ultrasound (CEUS) images and explore its clinical diagnostic efficacy. Methods A case-control trial was conducted on the clinical data of the patients with pathologically diagnosed hepatic tumors in a diameter ≤30 mm and undergoing CEUS examinations in the First Affiliated Hospital from June 2015 to June 2020.Finally, a total of 490 patients with 520 liver masses[474 malignant tumors (91.15%) and 46 benign tumors (8.85%)]were enrolled, including 406 males (82.86%) and 84 females (17.14%), with a mean age of 51.98±0.46(22~82) years.Four sonographers were invited to analyze the features of their conventional ultrasonographs and CEUS images, and a consensus needed to be reached through discussion when opinions differ.All enrolled patients were divided into a training set (n=400) and a testing set (n=90) in a ratio of 4:1.Conventional ultrasonographs, CEUS images, history of chronic liver disease and clinical indicators were jointly analyzed using machine learning methods, such as, support vector machines, random forest, nearest neighbor algorithm, and logistic regression.Accuracy, specificity, sensitivity, and area under the receiver operating characteristic curve (AUC) were calculated to evaluate the performance of the models. Results Among the 4 models, the random forest performed best, with an accuracy, sensitivity, specificity, and AUC of 0.97, 0.83, 0.71, and 0.987(95%CI: 0.934~1.000), respectively, in the test set.There was no significant difference in the AUC values in the random forest with the other 3 models (all P>0.05).The top 5 contributing features in random forest model were cirrhosis, age, diameters in ultrasound and CEUS, and portal phase enhancement pattern, which were consistent with the clinical diagnostic indicators of malignant liver tumors reported in previous studies, indicating that our established model had a good interpretability. Conclusion Our machine learning model is established based on CEUS features, chronic liver disease and tumor markers, and shows high accuracy in diagnosis of liver tumors in diameter ≤30 mm in CEUS.

Objective:To explore the relationship between the qualitative characteristics and quantitative parameters of contrast-enhanced ultrasound (CEUS) and clinicopathological features of breast cancer patients.Methods:According to the inclusion and exclusion criteria, the clinical data of 89 patients who received the CEUS and were pathologically diagnosed with breast cancer in the First Affiliated Hospital of Army Medical University from May 2021 to August 2022 were retrospectively analyzed. The CEUS qualitative characteristics (enhancement speed, enhancement degree, enhancement order, internal homogeneity, enhancement margin, perforator vessel, perfusion defect, size after enhancement) and quantitative parameters [wash-in slope (WIS), time to peak (TTP), peak intensity(PI), rise time(RT) and wash-in area under the curve(WiAUC)] in 89 patients were analyzed to explore their relationship with clinicopathological features. The quantitative parameters of CEUS were analyzed by the Mann-Whitney U test, qualitative characteristics were expressed by absolute numbers and analyzed by Pearson’s χ2 test or continuous correction χ2 test. The qualitative characteristics and quantitative parameters of CEUS with a statistically significant difference in univariate analysis were used as independent variables for binary logistic regression, with clinicopathological features as the dependent variables.Results:HER-2-positive breast cancer was more likely to show fast enhancement than HER-2-negative breast cancer (χ2=4.633, P=0.031). Compared with Ki-67 low expression breast cancer, Ki-67 high expression breast cancer was more likely to show hyperenhancement (χ2=4.355, P=0.037), and the size of lesions was usually larger after enhancement (χ2=4.355, P=0.037). Compared with histological grade 1/2 breast cancer, breast cancer of grade 3 was more likely to show perfusion defect (χ2=4.395, P=0.036). Breast cancer with a lesion diameter≥20 mm was more likely to show fast enhancement than the one < 20 mm (χ2=6.036, P=0.014). The WIS, PI and WiAUC of ER-negative breast cancer were significantly higher than those of ER-positive breast cancer (Z=-2.472, -2.870, -2.140; P=0.013, 0.004, 0.032). The WIS, PI and WiAUC of PR-negative breast cancer were significantly higher than those of PR-positive breast cancer (Z=-2.965, -3.361, -2.672; P=0.003, 0.001, 0.008). The WIS, PI and WiAUC of Ki-67 high expression breast cancer were significantly higher than those of Ki-67 low expression breast cancer (Z=-2.172, -2.713, -2.620; P=0.030, 0.007, 0.009). In addition, the WiAUC of HER-2-positive breast cancer was significantly higher than that of HER-2-negative breast cancer (Z=-2.161, P=0.031). The results of binary logistic regression analysis showed that PI was an independent predictor of ER expression (OR=0.907, 95%CI: 0.827-0.994, P=0.037); enhancement degree and WiAUC were independent predictors of Ki-67 expression(OR=5.082, 95%CI: 1.065-24.241, P=0.041; OR=1.030, 95%CI: 1.005-1.055, P=0.019).Conclusions:The qualitative characteristics and quantitative parameters of CEUS are related to clinicopathological features of breast cancer patients to a certain degree, which provides a reference for evaluating the prognosis of breast cancer in a non-invasive way.

目的 分析静脉注射用六氟化硫微泡在腹部超声检查中的安全性.方法 回顾性分析2006年1月至2021年9月于我院行静脉注射六氟化硫微泡腹部超声造影检查的91312例患者.收集发生不良反应的患者基本信息、症状和体征,总结不良反应的类型和严重程度、治疗及转归.结果 91312例患者中,35例(0.038％)发生不同程度不良反应;其中轻度18例、中度10例、重度7例,无死亡病例发生.不良反应症状包括过敏样反应7例,类生理反应28例.过敏样反应中,最常见是局部荨麻疹、瘙痒;类生理反应中,最常见是恶心、呕吐及血管迷走神经反应.35例不良反应中,23例(65.7％)年龄段为>40～60岁,31例(88.6％)有不同程度的肝功能异常,1例(2.9％)有磺胺类药物过敏史.34例(97.1％)不良反应发生在注射造影剂后10 min内,所有不良反应症状均于当日缓解.轻度不良反应中,12例休息后缓解,6例接受治疗后缓解;中度、重度不良反应均接受治疗后缓解.结论 静脉注射用六氟化硫微泡在腹部超声检查中不良反应发生率极低,具有极高的临床应用安全性.

Objective:To investigate the application value of contrast-enhanced ultra-sound, enhanced computed tomography (CT) and enhanced magnetic resonance imaging (MRI) in the diagnosis of small hepatocellular carcinoma.Methods:The clinical diagnositic trial was con-ducted. The clinicopathological data of 145 patients with small hepatocellular carcinoma who were admitted to the First Affiliated Hospital of Amy Medical University from January 2019 to June 2021 were collected. There were 121 males and 24 females, aged from 26 to 78 years, with a median age of 54 years. All patients were examined with contrast-enhanced ultrasound, enhanced CT and enhanced MRI, and underwent surgical resection of liver lesions within one month. Observation indicators: (1) postoperative histopathological examinations of patients with small hepatocellular carcinoma; (2) examination of small hepatocellular carcinoma by contrast-enhanced ultrasound, enhanced CT and enhanced MRI; (3) imaging features of small hepatocellular carcinoma in the contrast-enhanced ultrasound, enhanced CT and enhanced MRI; (4) enhancement mode distribution of small hepatocellular carcinoma in the arterial, portal and delayed phases of contrast-enhanced ultrasound, enhanced CT and enhanced MRI; (5) the efficacy of contrast-enhanced ultrasound, enhanced CT and enhanced MRI in the diagnosis of small hepatocellular carcinoma. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the Cochran′s Q test or the chi-square test. The sensitivity, specificity and accuracy were used to analyze the efficacy of contrast-enhanced ultrasound, enhanced CT and enhanced MRI in the diagnosis of small hepatocellular carcinoma. Results:(1) Postoperative histopathological examinations of patients with small hepatocellular carcinoma. There were 154 lesions detected in the postoperative histopathological examinations for the 145 small hepatocellular carcinoma patients, with the tumor diameter as (2.2±0.6)cm. (2) Examination of small hepatocellular carcinoma by contrast-enhanced ultrasound, enhanced CT and enhanced MRI. There were 153, 154 and 154 lesions detected in contrast-enhanced ultrasound, enhanced CT and enhanced MRI for the 145 patients with small hepatocellular carcinoma, respectively, with the detection rate as 99.35%(153/154), 100.00%(154/154) and 100.00%(154/154), showing no significant difference among the 3 imaging examination methods ( Q=2.00, P>0.05). (3) Imaging features of small hepatocellular carcinoma in the contrast-enhanced ultrasound, enhanced CT and enhanced MRI. Of the 153 lesions reported in contrast-enhanced ultrasound for patients with small hepatocellular carcinoma, 140 lesions showed "fast-in and fast-out" enhancement, 12 lesions showed "fast-in and slow-out" enhancement and 1 lesion showed isoenhancement in arterial phases and hypoenhancement in portal and delayed phase. Of the 154 lesions reported in enhanced CT for patients with small hepatocellular carcinoma, 112 lesions showed "fast-in and fast-out" enhancement, 13 lesions showed "fast-in and slow-out" enhancement, 14 lesions showed isoenhancement in arterial phase and hypoenhancement in portal and delayed phases, 5 lesions showed rim-like hyperenhancement in arterial phase and hypoenhancement in portal and delayed phases, 5 lesions showed hypoenhancement in the three phases, 3 lesions showed hyperenhancement in the three phases, 1 lesion showed isoenhancement in the three phases and 1 lesion showed isoenhancement in arterial and portal phases and hypoenhancement in delayed phase. Of the 154 lesions reported in enhanced MRI for patients with small hepatocellular carcinoma, 134 lesions showed "fast-in and fast-out" enhancement, 1 lesion showed "fast-in and slow-out" enhancement, 8 lesions showed isoenhancement in arterial phase and hypoenhance-ment in portal and delayed phases, 5 lesions showed rim-like hyperenhancement in arterial phase and hypoenhancement in portal and delay phases, 2 lesions showed rim-like hyperenhancement in the three phases, 1 lesion showed hyperenhancement in the three phases, 1 lesion showed hypoenhancement in the three phases, 1 lesion showed isoenhancement in arterial and portal phases and hypoenhancement in delayed late phase, 1 lesion showed edge delay enhancement in the three phases. (4) Enhancement mode distribution of small hepatocellular carcinoma in the arterial, portal and delayed phases of contrast-enhanced ultrasound, enhanced CT and enhanced MRI. Of the 153 lesions reported in contrast-enhanced ultrasound for patients with small hepatocellular carcinoma, there were 152 lesions with hyperenhancement and 1 lesion with iso or hypoenhance-ment in the arterial phase, there were 55 lesions with hyper or isoenhancement and 98 lesions with hypoenhancement in the portal venous phase, there were 12 lesions with hyper or isoenhancement and 141 lesions with hypoenhancement in the delayed phase. Of the 154 lesions reported in enhanced CT for patients with small hepatocellular carcinoma, there were 133 lesions with hyperen-hancement signal and 21 lesions with iso or hypoenhancement in the arterial phase, there were 53 lesions with hyper or isoenhancement and 101 lesions with hypoenhancement in the portal phase, there were 17 lesions with hyper or isoenhancement and 137 lesions with hypoenhancement in the delayed phase. Of the 154 lesions reported in enhanced MRI for patients with small hepatocellular carcinoma, there were 143 lesions with hyperenhancement and 11 lesions with iso or hypoenhance-ment in the arterial phase, there were 29 lesions with hyper or isoenhancement and 125 lesions with hypoenhancement in the portal phase, there were 5 lesions with hyper or isoenhancement and 149 lesions with hypoenhancement in the delayed phase. There were significant differences in the enhancement mode distribution of lesions in the arterial, portal and delayed phases among contrast-enhanced ultrasound, enhanced CT and enhanced MRI ( χ2=19.47, 13.21, 6.92, P<0.05). (5) The efficacy of contrast-enhanced ultrasound, enhanced CT and enhanced MRI in the diagnosis of small hepatocellular carcinoma. Of the 153 lesions reported in contrast-enhanced ultrasound for patients with small hepatocellular carcinoma, there were 3 lesions misdiagnosed according to the postoperative histopathological examinations. Of the 154 lesions reported in enhanced CT and enhanced MRI for patients with small hepatocellular carcinoma, there were 7 lesions and 2 lesions misdiagnosed according to the postoperative histopathological examinations, respectively. Lesions misdiagnosed in one imaging examination method were correctly diagnosed in the other two imaging examination methods. The sensitivity, specificity, accuracy were 97.4%, 63.0%, 92.3% for contrast-enhanced ultrasound in the diagnosis of small hepatocellular carcinoma. The above indica-tors were 95.5%, 63.0%, 90.6% for enhanced CT and 98.7%, 63.0%, 93.4% for enhanced MRI in the diagnosis of small hepatocellular carcinoma. There was no significant difference in the sensitivity and accuracy among the 3 imaging examination methods ( Q=2.92, 0.00, 1.81, P>0.05). Conclusion:Contrast-enhanced ultrasound, enhanced CT and enhanced MRI all have good diagnostic value in diagnosis of small hepatocellular carcinoma, and they complement each other.

OBJECTIVES:We aimed to evaluate the safety of the ultrasound contrast agent sulfur hexafluoride microbubbles in a large group of patients referred for routine contrast-enhanced ultrasound (CEUS).METHODS:A retrospective assessment was made of all patients that received sulfur hexafluoride microbubbles intravenously for CEUS at 24 centers between January 2006 and April 2019. Patient demographic details, examination type, and the dose of sulfur hexafluoride microbubbles administered were recorded with specific adverse events (AEs) documentation tools at each center. All AEs were recorded as serious or non-serious. Non-serious AEs were classified by intensity as mild, moderate, or severe according to ACR criteria. The frequencies of AEs across patient subgroups were compared using the chi-square test.RESULTS:A total of 463,434 examinations were evaluated. Overall, 157 AEs (153 [0.033%] non-serious; 4 [0.001%] serious) were reported after sulfur hexafluoride microbubbles administration, giving an AE frequency of 0.034% (157/463,434). Among the non-serious AEs, 66 (0.014%) were mild, 70 (0.015%) moderate, and 17 (0.004%) severe in intensity. The liver was the most common examination site, presenting an AE frequency of 0.026%. The highest AE frequency (0.092%) was for patients undergoing CEUS for vascular disease. There were no significant gender differences in either the total number or the severity of non-serious AEs (chi-square = 2.497, p = 0.287). The onset of AEs occurred within 30 min of sulfur hexafluoride microbubbles administration in 91% of cases.CONCLUSION:The frequency of AEs to sulfur hexafluoride microbubbles is very low and severe reactions are rare, confirming that sulfur hexafluoride microbubbles are appropriate for routine CEUS applications.KEY POINT:• The frequency of AEs to sulfur hexafluoride microbubbles is very low and severe reactions are rare.

Objectives To compare the performance of spleen stiffness measurement (SSM) and liver stiffness measurement (LSM) by sound touch elastography (STE) for the diagnosis of cirrhosis at different alanine aminotransferase (ALT) levels, and to compare the applicability and repeatability of SSM with LSM performed by STE, a new two-dimensional shear wave elastography technology. Methods This prospective multicenter study included 25 centers and recruited chronic hepatitis B (CHB) patients with liver biopsy between May 2018 and November 2019. All patients underwent LSM and SSM by STE. Success and reliability rates were calculated and compared. Intra-observer agreement was assessed using intraclass correlation coefficients (ICCs). Differences between areas under the receiver operating characteristic curves (AUCs) of LSMs and SSMs at different ALT levels were compared using the Delong test. Results Among 603 CHB patients, the success and reliability rates of SSM were 94.53% (570/603) and 85.74% (517/603), respectively, which were similar to those of LSM (p > 0.05), respectively. The ICC for intra-observer agreements of SSM was 0.964 (p < 0.001). In the total cohort, ALT <= 2 x upper limit of normal (ULN) group, and A0-1 group, the AUCs of SSMs were significantly lower than those of LSMs for the diagnosis of cirrhosis (p < 0.001). In the ALT > 2 x ULN group and A2-3 group, the AUC of SSM improved and was not significantly different from that of LSM (p = 0.342, p = 0.510, respectively). Conclusions SSM by STE achieved applicability and repeatability equivalent to those of LSM. SSM might be a good substitute to LSM in patients with high ALT levels.

Background:Routine clinical factors play an important role in the clinical diagnosis of focal liver lesions (FLLs); however, they are rarely used in computer-assisted diagnosis. Therefore, we developed a deep learning (DL) radiomics model, and investigated its effectiveness in diagnosing FLLs using long-range contrast-enhanced ultrasound (CEUS) cines and clinical factors.Methods:Herein, 303 patients with pathologically confirmed FLLs after surgery at three hospitals were retrospectively enrolled and divided into a training cohort (n=203), internal validation (IV) cohort (n=50) from one hospital with the ratio of 4:1, and external validation (EV) cohort (n=50) from the other two hospitals. Four DL radiomics models, namely Four Stream 3D convolutional neural network (FS3DU) (trained with CEUS cines only), FS3DU+A (trained with CEUS cines and alpha fetoprotein), FS3DU+H (trained with CEUS cines and hepatitis), and FS3DU+A+H (trained with CEUS cines, alpha fetoprotein, and hepatitis), were formed based on 3D convolutional neural networks (CNNs). They used approximately 20-s preoperative CEUS cines and/or clinical factors to extract spatiotemporal features for the classification of FLLs and the location of the region of interest. The area under curve of the receiver operating characteristic and diagnosis speed were calculated to evaluate the models in the IV and EV cohorts, and they were compared with those of two radiologists. Two-sided Delong tests were used to calculate the statistical differences between the models and radiologists.Results:FS3DU+A+H, which incorporated CEUS cines, hepatitis, and alpha fetoprotein, achieved the highest area under curve of 0.969 (95% CI: 0.901-1.000) and 0.957 (95% CI: 0.894-1.000) among radiologists and other models in IV and EV cohorts, respectively. A significant difference was observed when comparing FS3DU and radiologist 2 (all P<0.05). The diagnosis speed of all the models was the same (10.76 s per patient), and it was two times faster than those of the radiologists (radiologist 1: 23.74 and 27.75 s; radiologist 2: 25.95 and 29.50 s in IV and EV cohorts, respectively).Conclusions:The proposed DL radiomics demonstrated excellent performance on the benign and malignant diagnosis of FLLs by combining CEUS cines and clinical factors. It could help the individualized characterization of FLLs, and enhance the accuracy of diagnosis in the future.

Purpose To explore the diagnostic value of American College of Radiology Contrast-Enhanced Ultrasound-Liver Imaging Reporting and Data System (ACR-CEUS-LI-RADS) for hepatocellular carcinoma (HCC) in patients with cirrhosis and chronic hepatitis B. Methods A total of 205 patients at high risk of HCC with solitary hepatic nodule were enrolled and retrospectively analyzed. All patients were over 18 years old and had a single lesion with a diameter < 50 mm. Lesions were categorized according to size and contrast enhancement patterns in the arterial, portal venous and late phases. Diagnostic efficacy of CEUS LI-RADS for HCC, and the rate of non-HCC malignancies in the LR-M class were compared between patients with cirrhosis and chronic hepatitis B. Results Of all 205 nodules (median nodule size was 34 mm), 142 (69.3%) were HCC. Of the 127 (61.9%) LR-5 category nodules, 95.8% (92/96) nodules were corresponded to HCC in cirrhosis, while 61.3% (19/31) nodules were corresponded to HCC in chronic hepatitis B (P = 0.000). Positive predictive value (PPV) of LR-5 category for HCC was 95.8% in cirrhosis and 61.3% in chronic hepatitis B (P = 0.000). More category of LR-4 nodules were proved to be HCC in patients with cirrhosis than chronic hepatitis B (80.0% vs 8.3%, P = 0.000). Of 41 LR-M category nodules, more non-HCC malignancies were found in chronic hepatitis B (76.0%) than that in cirrhosis (25.0%, P = 0.001). Conclusions The LR-5 category is highly specific for the diagnosis of HCC in patients with cirrhosis. However, LR-5 category nodules require further CT or MRI examination or histological confirmation in patients with chronic hepatitis B for its unsatisfactory PPV for HCC.

目的 对比分析超声造影引导下单极射频消融(M-RFA)与无接触多极射频消融(No-touch RFA)治疗肝肿瘤的临床应用价值.方法 回顾性分析在我院行超声造影引导下M-RFA和No-touch RFA治疗肝肿瘤的94例患者(M-RFA组44例,No-touch RFA组50例)的检查资料,比较两组患者术后病灶灭活范围和灭活率,以及治疗前后实验室检查指标的差异;随访24个月,观察患者的无瘤生存率.结果 射频消融后,超声造影测量M-RFA组肿瘤灭活范围平均值为38.36 mm×31.31 mm,No-touch RFA组为46.70 mm×35.82 mm;M-RFA组完全灭活率为90.9％(40/44),No-touch RFA组为98.00％(49/50),差异有统计学意义(P<0.05).M-RFA组21例患者甲胎蛋白阳性,RFA术后1个月9例明显下降,12例转阴;No-touch RFA组20例患者甲胎蛋白阳性,RFA术后1个月6例明显下降,14例转阴,两组术前术后比较差异均有统计学意义(均P<0.001).术后随访24个月,M-RFA组无瘤生存率为47.72％(21/44),No-touch RFA组为68.00％(34/50),差异有统计学意义(P=0.041).结论 超声造影引导下No-touch RFA治疗肝肿瘤有助于提高肿瘤的灭活率,疗效显著,无瘤生存率高,较M-RFA临床应用价值更佳.

目的 探讨甲状腺乳头状癌(PTC)超声造影特征与微血管密度(MVD)的相关性.方法 回顾性分析于我院超声科行甲状腺超声造影检查的甲状腺结节患者61例(共61个结节),分析其超声造影增强特征,并与其手术病理结果对照.应用CD31免疫组化法计数PTC结节的微血管密度(MVD),采用Pearson法分析超声造影定量参数与MVD的相关性.结果 超声造影显示55个结节呈不均匀低增强,其诊断准确率为90.1％.PTC超声造影时间-强度曲线的峰值强度(PI)及曲线下面积(AUC)分别为(14.47±6.42)dB、(603.1±222.80)dB·s,低于周围正常甲状腺实质的(21.06±5.65)dB、(1025.43±260.37)dB·s,差异均有统计学意义(均P<0.05).CD31免疫组化染色计数PTC结节的平均MVD值为(64.99±17.51)条/HP,低于周边正常甲状腺组织的(91.71±7.54)条/HP,差异有统计学意义(P<0.05).相关性分析显示,PI、AUC与MVD均呈正相关(r=0.811、0.734,均P<0.001).结论 超声造影定量参数可以反映PTC的微血管,为临床评估PTC的MVD提供了一种无创性术前检测方法.

Objective:To investigate the clinical value of contrast-enhanced ultrasound and gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA MRI) in the diagnosis of hepatocellular carcinoma (HCC).Methods:The clinically diagnostic test was conducted. The clinicopathological data of 274 lesions in 250 patients with liver neoplasms who were admitted to the First Hospital Affiliated to Army Medical University from January 2017 to December 2018 were collected. There were 204 males and 46 females, aged (52±11)years, with a range from 22 to 78 years. Patients underwent contrast-enhanced ultrasound and Gd-EOB-DTPA MRI, and they received surgical resection or biopsy within one month. Images was read and analyzed by two senior radiologists for diagnosis. Observation indicators: (1) imaging features of contrast-enhanced ultrasound and Gd-EOB-DTPA MRI, including ① imaging features of contrast-enhanced ultrasound, ② imaging features of Gd-EOB-DTPA MRI, ③ enhanced imaging manifestation in different phases of 223 HCC lesions; (2) dignostic performance of contrast-enhanced ultrasound, Gd-EOB-DTPA MRI, or the combined examinations for HCC diagnosis, including ① sensitivity, specificity and accuracy rate of the three methods for HCC diagnosis and ② sensitivity, specificity and accuracy rate of the three methods for HCC diagnosis in lesions with different diameters. Count data were represented as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. With the pathological examination as the golden criteria of diagnosis, the sensitivity, specificity and accuracy rate of the contrast-enhanced ultrasound, Gd-EOB-DTPA MRI, or the combined examinations for HCC diagnosis were calculated.Results:(1) Imaging features of contrast-enhanced ultrasound and Gd-EOB-DTPA MRI. ① Imaging features of contrast-enhanced ultrasound: of the 223 HCC lesions on contrast-enhanced ultrasound, 167 lesions were accorded with fast in fast out of HCC, 7 were missed diagnosed and 49 were misdiagnosed. Of the 51 non-HCC lesions on contrast-enhanced ultrasound, 7 lesions were accorded with fast in fast out, including 3 of combined hepatocellular-cholangiocarcinoma, 2 of intrahepatic cholangiocarcinoma, 1 of neuroendocrine tumor, 1 of inflammatory granuloma, 44 lesions were no fast in fast out. ② Imaging features of Gd-EOB-DTPA MRI: of the 223 HCC lesions on Gd-EOB-DTPA MRI, 178 lesions were accorded with fast in fast out of HCC, 1 was missed diagnosed and 44 were misdiagnosed. Of the 51 non-HCC lesions on Gd-EOB-DTPA MRI, 5 lesions were accorded with fast in fast out, inlcuding 2 of intrahepatic cholangiocarcinoma, 1 of combined hepatocellular-cholangiocarcinoma, 1 of neuroendocrine tumor, 1 of inflammatory granuloma, 46 lesions were no fast in fast out. ③ Enhanced imaging manifestation in different phases of 223 HCC lesions. In arterial phase, 92.83%(207/223) of the lesions displayed hyper-enhanced on contrast-enhanced ultrasound, and 80.72%(180/223) of the lesions displayed hyper-enhanced on Gd-EOB-DTPA MRI, showing a significant difference ( χ2=14.240, P<0.05). In portal vein phase or late phase, 78.48%(175/223) of the lesions displayed hypo-enhanced on contrast-enhanced ultrasound, and 96.41%(215/223) of the lesions displayed hypo-enhanced on Gd-EOB-DTPA MRI, showing a significant difference ( χ2=32.674, P<0.05). On Gd-EOB-DTPA MRI, 96.41%(215/223) of the lesions displayed low signals in portal-vein phase or late phase, and 98.21%(219/223) of the lesions displayed low signals in hepatobiliary phase, showing no significant difference ( χ2=1.370, P>0.05). (2) Dignostic performance of contrast-enhanced ultrasound, Gd-EOB-DTPA MRI, or the combined examinations for HCC diagnosis. ① Sensitivity, specificity and accuracy rate of the three methods for HCC diagnosis: the sensitivities of contrast-enhanced ultrasound, Gd-EOB-DTPA MRI, or the combined examinations for HCC diagnosis were 74.89%(167/223), 79.82%(178/223), 94.62%(211/223), respectively. The specificities of contrast-enhanced ultrasound, Gd-EOB-DTPA MRI, or the combined examinations for HCC diagnosis were 86.27%(44/51), 90.20%(46/51), 80.39%(41/51). The accuracy rates of contrast-enhanced ultrasound, Gd-EOB-DTPA MRI, or the combined examinations for HCC diagnosis were 77.01%(211/274), 81.75%(224/274), 91.97%(252/274). There were significant differences in the sensitivity and accuracy rate among the three methods ( χ2=33.499, 23.345, P<0.05). There was no significant difference in the specificity among the three methods ( χ2=2.017, P>0.05). ② Sensitivity, specificity and accuracy rate of the three methods for HCC diagnosis in lesions with different diameters: 128 of 274 lesions had the maximun diameter>3 cm and ≤5 cm, 92 lesions had the maximun diameter >2 cm and ≤3 cm, 54 lesions had the maximun diameter≤ 2 cm. The sensitivities of contrast-enhanced ultrasound for HCC diagnosis in lesions with the maximun diameter>3 cm and ≤5 cm, >2 cm and ≤3 cm, ≤2 cm were 81.19%(82/101), 76.92%(60/78), 56.82%(25/44), the specificities were 92.59%(25/27), 71.43%(10/14), 90.00%(9/10), and the accuracy rates were 83.59%(107/128), 76.09%(70/92), 62.96%(34/54), respectively. The sensitivities of Gd-EOB-DTPA MRI for HCC diagnosis in lesions with the maximun diameter>3 cm and ≤5 cm, >2 cm and ≤3 cm, ≤2 cm were 83.17%(84/101), 79.49%(62/78), 72.73%(32/44), the specificities were 96.30%(26/27), 85.71%(12/14), 80.00%(8/10), and the accuracy rates were 85.94%(110/128), 80.43%(74/92), 74.07%(40/54), respectively. The sensitivities of contrast-enhanced ultrasound combined with Gd-EOB-DTPA MRI for HCC diagnosis in lesions with the maximun diameter>3 cm and ≤5 cm, >2 cm and ≤3 cm, ≤2 cm were 95.05%(96/101), 96.15%(75/78), 90.91%(40/44), the specificities were 92.59%(25/27), 57.14%(8/14), 80.00%(8/10), and the accuracy rates were 94.53%(121/128), 90.22%(83/92), 88.89%(48/54), respectively. There were significant differences in the sensitivities for HCC diagnosis in lesions with the maximun diameter>3 cm and ≤5 cm, >2 cm and ≤3 cm, ≤2 cm among the three methods ( χ2=9.703, 12.777, 13.142, P<0.05). There were also significant differences in the accuracy rates ( χ2=8.051, 6.600, 9.826, P<0.05). There was no significant difference in the specificies ( P>0.05). Conclusions:There was no significant difference in the dignostic performance for HCC diagnosis between contrast-enhanced ultrasound and Gd-EOB-DTPA MRI, and the combination of contrast-enhanced ultrasound and Gd-EOB-DTPA MRI can improve the diagnostic sensitivity and accuracy rate of HCC.

目的 分析肝脏局灶性结节状增生(FNH)的超声造影增强模式及特征性表现,探讨超声造影对FNH定性诊断的临床应用价值.方法 选取112例经病理证实且术前曾行超声造影检查的FNH患者,回顾性分析其临床资料及超声图像特征.结果 112例FNH患者,88例病灶呈低回声,16例呈高回声,8例呈等回声;CDFI于31例病灶内探及轮辐状血流信号,35例探及短线状血流信号,42例探及点状血流信号,余4例无明显血流信号.超声造影于动脉相、门脉相、延迟相表现为"高-高-高"增强49例,"高-等-等"增强44例,"高-高-等"增强9例,"高-等-低"增强9例,"高-低-低"增强1例.其中62例离心性增强,59例出现轮辐状动脉,52例中央可见呈纵行短线状或星芒状瘢痕.二维超声诊断符合率32.14％(36/112),超声造影诊断符合率89.28％(100/112).结论 超声造影能明显提高FNH的诊断符合率,对FNH的定性诊断具有重要的临床价值.

Objective To investigate the clinical value of contrast-enhanced ultrasonography (CEUS) combined with time-intensity curve (TIC) analysis in differential diagnosis of benign and malignant thyroid nodules. Methods We conducted a retrospective study of 114 patients with 175 thyroid nodules detected by CEUS in our hospital between August, 2016 and September, 2017 and compared the enhancement patterns and TIC of CEUS between benign and malignant thyroid nodules. All the patients underwent surgical resection of the nodules and the findings of CEUS were compared with the results of surgical pathology. Results CEUS identified 93 benign nodules and 82 malignant nodules, while the pathological results confirmed 98 benign nodules (29 adenomas and 69 nodular goiters) and 77 malignant nodules (papillary carcinoma). CEUS had a diagnostic sensitivity of 85.7% for malignant thyroid nodules with a specificity of 83.6% and an accuracy of 84.5%. CEUS showed homogeneous hyperenhancement or isoenhancement in 58.1% (57/98) of thyroid adenomas and nodular goiters, and heterogeneous hypoenhancement in 71.4% (55/77) of malignant thyroid nodules. TIC analysis showed that compared with the surrounding thyroid tissue, thyroid adenomas showed a rapid entry in CEUS with a steep ascending branch and a higher peak intensity (P < 0.05); nodular goiters also showed a rapid entry and a steep ascending branch but with a peak intensity consistent with that of the surrounding thyroid tissue. CEUS of thyroid carcinoma showed a slow entry, a relatively flat ascending branch, and a low peak intensity (P < 0.05). The peak intensity of thyroid carcinomas was significantly lower than that of benign thyroid nodules (P < 0.05), but the time to peak and arrival time were comparable between benign and malignant thyroid nodules (P>0.05). Conclusion Benign and malignant thyroid nodules commonly present with different characteristics in CEUS. Thyroid carcinomas (papillary carcinomas) are typically characterized by slow and heterogeneous hypoenhancement in CEUS, while benign thyroid nodules feature a rapid hyper- or isoenhancement. CEUS combined with quantitative analysis can improve the diagnostic accuracy for malignant thyroid nodules

Objective To investigate the application value of ultrasound-guided fine needle aspiration biopsy (FNAB) for thyroid micro/small nodules and the key points of the cooperation between nurses and patients. Methods A total of 1 109 patients with small thyroid nodules (maximum diameter≤10.0 mm) who underwent aspiration with ultrasound guidance in our department from January to December 2018 were enrolled in this study. They were divided into small nodule group (maximum diameter >5.0~10.0 mm) and micro nodule group (maximum diameter ≤5.0 mm). The satisfaction rate of aspirated tissue samples for FNAB and the pathological results were compared between the 2 group. Individually clinical care and psychological counseling were provided by specialized nurses to guide the patients to cooperate closely in the procedure. Results Among the 1 109 patients, 718 patients were identified with small thyroid nodules and 391 patients with micro nodules, and all of them accepted ultrasound-guided FNAB successfully. Only 2 patients underwent a second puncture due to the puncture needle shifting because of their swallowing during the examination. Satisfaction rates of harvested samples were 94.85% in the small nodule group and 91.30%, in the micro nodule group, and the rates of undiagnosed cases were 5.15% and 8.70% in the 2 groups respectively. The incidence of complications was 1.71% (19/1 109), and 2 cases of them experienced fissure-like hemorrhage in the right lobe of the thyroid after the procedure. After targeted psychological counseling and nursing, the hemorrhage stopped in ultrasound examination in 1 h later. The other 17 patients had all symptoms alleviated though no special treatment, and no serious complications occurred. Conclusion FNAB is a safe and effective procedure to confirm the pathological changes of thyroid small nodules. Individualized nursing care can improve the success rate of the puncture and rate of pathological diagnosis, improve the emotional state of patients and reduce the incidence of postoperative complications.

To evaluate the correlations between the enhancement pattern of intrahepatic cholangiocarcinoma (ICC) on contrast-enhanced ultrasound (CEUS) and clinicopathologic findings and prognosis, a retrospective study was performed on 197 patients with mass-forming ICC who underwent pre-operative CEUS and surgical resection. The contrast medium we employed in CEUS was SonoVue, which contains microbubbles consisting of sulfur hexafluoride bubbles within a phospholipid shell. This study was approved by the institutional review board with informed consent waived. Patients were classified into an arterial rim-like enhancement group or an arterial non-rim-like enhancement group, and arterial enhancement patterns were correlated with clinicopathologic factors. Overall survival (OS) times were calculated using the Kaplan-Meier method, and differences between groups were compared with the log-rank test. Univariate and multivariate Cox regression models for OS were used to evaluate the independent prognostic factors. The mean and range of ICC tumor size of the arterial rim-like group (59.41 +/- 22.09 mm, 20-100 mm) were similar to those of the arterial non-rim-like group (59.82 +/- 30.35 mm, 14-162 mm, p = 0.914). Arterial enhancement patterns were correlated with chronic viral hepatitis or cirrhosis, vascular invasion, lymph node metastasis and single/multiple tumors. A total of 78 patients (39.6%) exhibited arterial rim-like enhancement, and the other 119 patients (60.4%) exhibited arterial non-rim like enhancement. Arterial enhancement pattern (p = 0.045), vascular invasion (p = 0.005), lymph node metastasis (p = 0.000) and number of tumors (p = 0.001) were independent prognostic factors for OS. The arterial non-rim like enhancement pattern of ICC on CEUS is an independent prognostic factor for better OS and may offer new information for predicting the prognosis of ICC patients before surgical resection. (C) 2018 World Federation for Ultrasound in Medicine & Biology. All rights reserved.

目的:将声诺维应用于患者子宫输卵管超声造影之中,探究声诺维在诊断不孕症患者输卵管通畅性的应用价值.方法:对2017年8月—2018年3月我院妇产科收治的40例输卵管病变患者行腹腔镜下输卵管通畅染液术以及声诺维进行超声造影的4D-HyCoSy检查,以腹腔镜检的结果为金标准,判断声诺维用作造影剂检查输卵管是否通畅的诊断准确性.结果:40例(含80条输卵管)检查的患者超声显示出76条,造影超声显示率95.0％.声诺维作为造影剂的阳性诊断率为91.25％,检测灵敏度为86.5％,有效诊断率为96.1％,超声造影的检测结果与患者腹腔镜检的结果差异不显著.结论:声诺维应用于患者子宫输卵管超声造影之中,图像更直观更快速地了解患者的输卵管病变情况,超声诊断的灵敏性和准确性有一定的保障.有助于临床对输卵管堵塞造成不孕症患者的诊断.

Objective To comparatively analyze the image characteristic of contrast-enhanced ultrasound(CEUS)and contrast-enhanced computed tomography(CECT),and explore the diagnostic value of the two methods in benign and malignant lesions of gallbladder.Methods comparative analysis the image characteristic of CEUS and CECT,the preoperative diagnostic results of 86 cases of gallbladder diseases were confirmed by pathology.Results The enhancement patterns of CEUS and CECT in benign and malignant lesions of gallbladder are similar.The sensitivity,specificity and accuracy of CEUS were 77.9%(53/68),77.8%(14/18),77.9%(67/86),respectively.The sensitivity,specificity and accuracy of CECT were 75%(51/68),55.6%(10/18),70.9%(61/86),respectively.The sensitivity,specificity and accuracy of the combination of CEUS and CECT were 83.8%(57/68),55.6%(10/18),77.9%(67/86),respectively.The accuracy of the combination of CEUS and CECT was higher than that of CECT in the diagnosis of malignant gallbladder lesions [(53.9±10.00)s vs(35.50±6.72)s],the differences were statistically significant(t=6.729,P＜0.001).Conclusions The enhancement patterns of CEUS and CECT in benign and malignant gallbladder lesions are similar.The combination of CEUS and CECT is helpful for improving the diagnostic accuracy of malignant gallbladder lesions.CEUS and CECT could corroborate and complement each other,and provide more valuable information for the differential diagnosis of benign and malignant gallbladder lesions.

This study aimed to analyze the influence of the cellular differentiation, the tumor size and the underlying hepatic condition on the enhancement pattern of hepatocellular carcinoma (HCC) on contrast-enhanced ultrasound (CEUS). 276 patients with single lesion ≤ 5 cm who underwent CEUS exam and were pathologically confirmed as HCC were retrospectively enrolled. Enhancement patterns, washout patterns, wash-in time and washout time were observed and recorded. During the arterial phase, more poorly differentiated HCCs (42.5%) and lesions > 3 cm (35.2%) performed inhomogeneous enhancement (p < 0.05). More well differentiated HCCs (63.4%) performed late washout or no washout while compared with moderately (37.8%) or poorly (24.1%) differentiated HCCs (p < 0.05). Poorly differentiated HCCs showed the shortest washout time (83.0 ± 39.8 s), moderately differentiated HCCs showed the moderate washout time (100.4 ± 52.1 s), and well differentiated HCCs showed the longest washout time (132.3 ± 54.2 s) (p < 0.05). Lesions > 3 cm (97.2 ± 51.3 s) washed out more rapidly than lesions ≤ 3 cm (113.9 ± 53.5 s) (p < 0.05). The dynamic enhancement procedure of HCC was influenced by the cellular differentiation and the tumor size. While, hepatic background showed no influence on the dynamic enhancement of HCC.

Objective To investigate the application value of contrast-enhanced transrectal ultrasound (CE-TRUS) in differential diagnosis of prostate benign and malignant lesions. Methods A retrospective analysis of patients with prostate lesions detected by CE-TRUS from January 2014 to December 2016 in Southwest Hospital of Third Military Medical University was performed. Seventy-two cases of prostate disease with 88 lesions were confirmed by transrectal prostate biopsy under ultrasound guidance. The age of patients with benign and malignant lesions, serum prostate specific antigen (PSA), and the size of prostate and prostate inner gland were compared by independent sample t test. Pathologic results of transrectal prostate biopsy under ultrasound guidance were used as diagnostic gold standard, and the sensitivity, specificity and accuracy of CE-TRUS in diagnosis of benign and malignant prostate lesions were calculated. Results Sixty- seven lesions in 52 patients were benign prostatic diseases, and 21 lesions in 20 patients were prostate cancer in this study. The size of prostate and prostate inner gland were not different between patients with prostate cancer and benign prostatic diseases [(58.33±34.99) cm3vs (57.14±24.42) cm3, t=0.185, P=0.854; (34.98±19.96) cm3vs (33.89±17.65) cm3, t=0.213, P=0.832]. Most of prostate cancer lesions were in prostate outer gland area (15/21), and contrast-enhanced ultrasound imaging showed contrast enhancement increased mostly in arterial phase and faded faster than the surrounding tissues (16/21). However, most of prostate benign lesions were in prostate inner gland (47/67), and contrast-enhanced ultrasound imaging showed contrast enhancement was mostly equal with the surrounding tissue in arterial phase and faded the same as the surrounding tissues in venous phase (47/67). Pathologic results of transrectal prostate biopsy under ultrasound guidance were used as diagnostic gold standard, the sensitivity of CE-TRUS in diagnosis of benign and malignant prostate lesions was 85.71%, the specificity was 91.04%, and the accuracy was 89.77%. Two lesions were in prostate inner and outer gland border areas in the three missed prostate cancer lesions, and Gleason scores were all medium and high differentiated group. Six prostate benign lesions were diagnosed as malignant lesions, five lesions were confirmed prostate hyperplasia with chronic prostatitis and one was confirmed granulomatous inflammation with coagulation necrosis by transrectal prostate biopsy under ultrasound guidance. Conclusion CE-TRUS can effectively identify prostate benign and malignant lesions, and provides reliable information for accurate diagnosis of prostate cancer.