We investigated the role of ultrasound localization microscopy (ULM) qualitative and quantitative parameters in distinguishing benign from malignant breast lesions. The ULM qualitative and quantitative parameters of breast lesions were recorded. A receiver operating characteristic (ROC) curve was applied to assess the diagnostic performance of ULM. Intra- and inter-operator reliabilities of quantitative parameters were assessed. Thirty-one breast lesions were verified by pathologic results, 14 of which were benign and 17 were malignant. Benign lesions were associated with dot-like, line-like, or branch-like patterns (93 https://www.chictr.org.cn/ .

Benign and malignant breast tumors differ in their microvasculature morphology and distribution. Histologic biomarkers of malignant breast tumors are also correlated with the microvasculature. There is a lack of imaging technology for evaluating the microvasculature. Ultrasound localization microscopy (ULM) can provide detailed microvascular architecture at super-resolution. The objective of this trial is to explore the role of ULM in distinguishing benign from malignant breast tumors and to explore the correlations between ULM qualitative and quantitative parameters and histologic biomarkers in malignant breast tumors. This prospective and multicenter study will include 83 patients with breast tumors that will undergo ULM. 55 patients will be assigned to the malignant group, and 28 patients will be assigned to the benign group. The primary outcome is the differences in the qualitative parameters (microvasculature morphology, distribution, and flow direction) between benign and malignant breast tumors on ULM. Secondary outcomes include (1) differences in the quantitative parameters (microvasculature density, tortuosity, diameter, and flow velocity) between benign and malignant breast tumors based on ULM; (2) diagnostic performance of the qualitative parameters in distinguishing benign and malignant breast tumors; (3) diagnostic performance of the quantitative parameters in distinguishing benign and malignant breast tumors; (4) relationships between the qualitative parameters and histologic biomarkers in malignant breast tumors; (5) relationships between the quantitative parameters and histologic biomarkers in malignant breast tumors; and (6) the evaluation of inter-reader and intra-reader reproducibility. Detecting vascularity in breast tumors is of great significance to differentiate benign from malignant tumors and to predict histologic biomarkers. These histologic biomarkers, such as ER, PR, HER2 and Ki67, are closely related to prognosis evaluation. This trial will provide maximum information about the microvasculature of breast tumors and thereby will help with the formulation of subsequent differential diagnosis and the prediction of histologic biomarkers. Chinese Clinical Trial Registry ChiCTR2100048361/6th/July/2021. This study is a part of that clinical trial.

目的 观察肌骨超声断层成像用于膝关节置换术后评估的临床价值.方法 回顾性分析10例因骨肉瘤接受膝关节置换术患者的影像学资料,记录每项检查所用时间;针对检查区域二维和三维重建图像比较各检查方法成像速度及图像质量.结果 CT、MRI及超声断层检查时间分别为(39.0±7.6)s、(332.8±48.9)s及(117.0±9.6)s,CT最快而MRI最慢.C T和M RI中的金属伪影及图像变形导致图像质量降低,影响诊断效能.超声断层成像用于观察假体周围软组织不受金属伪影影响,扫描时间较短、层面连续、图像分辨力较高,且支持三维重建,能有效评估关节假体周围软组织和积液情况,可提供更全面的软组织信息及更直观的立体图像.结论 超声断层成像可作为无创方法用于膝关节置换术后评估.

ObjectiveWe explored the role of maximum intensity projection (MIP) based on high frame rate contrast-enhanced ultrasound (H-CEUS) for the differentiation of breast tumors.MethodsMIP imaging was performed in patients with breast tumors who underwent H-CEUS examinations. The microvasculature morphology of breast tumors was assessed. The receiver operating characteristic curve was plotted to evaluate the diagnostic performance of MIP.ResultsForty-three breast tumors were finally analyzed, consisting of 19 benign and 24 malignant tumors. For the ≤30-s and >30-s phases, dot-, line-, or branch-like patterns were significantly more common in benign tumors. A tree-like pattern was only present in the benign tumors. A crab claw-like pattern was significantly more common in the malignant tumors. Among the tumors with crab claw-like patterns, three cases of malignant tumors had multiple parallel small spiculated vessels. There were significant differences in the microvasculature morphology for the ≤30-s and >30-s phases between the benign and malignant tumors (all p < 0.001). The area under the curve, sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the ≤30-s phase were all higher than those of the >30-s phase for the classification of breast tumors.ConclusionMIP based on H-CEUS can be used for the differentiation of breast tumors, and the ≤30-s phase had a better diagnostic value. Multiple parallel small spiculated vessels were a new finding, which could provide new insight for the subsequent study of breast tumors.

Cosmetic skin diseases are a part of many dermatological concerns brought up by patients, which negatively affect mental health and quality of life. Imaging technology has an established role in the diagnosis of cosmetic skin diseases by recognizing information on deep skin lesions. Due to the complex physiological and pathological nature of cosmetic skin diseases, the diagnostic imaging performance varies greatly. Developing noninvasive technology models with wide applicability, particularly high-frequency ultrasound (HFUS), which is able to achieve high-resolution imaging of the skin from the stratum corneum down to the deep fascia, is of great significance to medical cosmetology. To explore the great potential of HFUS in cosmetic skin diseases, a narrative review of literature from PubMed and Web of Science published between 1985 and 2022 was conducted. This narrative review focuses on the progression of HFUS imaging in medical cosmetology, especially on its promising application in the quantitative evaluation and differential diagnosis of cutaneous pathological scar, port wine stain (PWS), acne, skin aging, and other cosmetic applications.

目的 分析比较肌骨超声、X线、CT、MRI及实验室指标对强直性脊柱炎(AS)的诊断效能,探讨肌骨超声诊断AS的临床应用价值.方法 选取我院拟诊为AS的患者82例,均行肌骨超声、X线、CT、MRI、血清超敏C反应蛋白和红细胞沉降率检查,根据人类白细胞抗原检测结果,分为阳性69例(病例组)和阴性13例(对照组),分析并比较肌骨超声与上述其他检查方式在AS临床诊断中的效能.结果 两组性别比、年龄、血清高敏C反应蛋白、红细胞沉降率比较,差异均无统计学意义;两组超声、CT、X线、MRI的AS阳性检出率比较,差异均有统计学意义(均P<0.05);超声与X线、CT、MRI对AS的检出率比较,差异均无统计学意义.超声与MRI诊断AS炎症期的检出率比较差异无统计学意义.超声与实验室炎症指标在判断骶髂关节炎症方面比较差异无统计学意义.结论 肌骨超声可以作为诊断AS的重要影像学手段,特别是在AS炎症期,超声检出率可以媲美MRI.

Clinical and experimental findings have disclosed a high recurrence rate after radiofrequency ablation (RFA), which might be due to the dissemination of malignant cells into the vasculature during ablation. Here, we apply in vivo flow cytometry (IVFC) to monitor circulating tumor cells (CTCs) while performing ablation in a real-time and noninvasive way in an orthotopic model of prostate cancer. We report that CTCs are dramatically increased during RFA. The CTCs induced by ablation eventually translate into enhanced distant metastasis and reduced survival as compared to resection. Immunofluorescence analysis reveals that RFA significantly increases the infiltration of tumor-associated macrophages (TAMs) in the lung. Our study thus suggests that the ablative procedure of prostate tumors causes immediate tumor cell dissemination and increases distant metastasis.

Objectives: To assess the combined diagnostic strategy of contrast-enhanced ultrasound (CEUS) and acoustic radiation force impulse (ARFI) in the precise differential diagnosis of clear cell renal cell carcinoma (CCRCC) and urothelium carcinoma of the renal pelvis (UCRP) with other small renal tumors (SRTs) < 3cm in size. Methods: The elastography self-corrected CEUS (ESC) mode was established to perform the quantitative differential diagnosis of SRTs (<3 cm). The kidney shear wave velocity (SWV) value recorded by ARFI showed substantial variability in patients with CCRCC (high elasticity value) and UCRP (low elasticity value) compared with other renal masses, thus providing critical self-correction information for the ultrasound differential diagnosis of SRTs. Results: In this work, the ESC observations and the corresponding ESC criteria show a remarkable 94.6% accuracy in reference to the gold standards, thus allowing the quantitative, early triple distinction of CCRCC with UCRP and other SRTs in patients with suspicious SRTs. Conclusions: This ARFI self-corrected CEUS diagnostic strategy is far beyond a screening method and may have the potential to identify a window of therapeutic opportunity in which emerging therapies might be applied to patients with CCRCC and UCRP, reducing overtreatment and medical costs. Advances in knowledge: In our study, a new rapid and non-invasive elastography self-corrected CEUS (ESC) ultrasound imaging mode was developed, which was useful in the triple distinction of CCRCC, UCRP, and other SRTs with 94.6% accuracy. ESC is a promising method in the differential diagnosis of SRTs with accuracy and practicability far beyond a single screening model.

Totally 85 patients with 93 renal lesions who underwent contrast-enhanced ultrasound (CEUS) were retrospectively studied with quantitative analysis to evaluate its value in the differential diagnosis of renal tumor histotypes. CEUS characteristics were analysed including the enhancement patterns, peak intensity, homogeneity of enhancement, and pseudocapsule. Quantitative parameters of peak intensity (P) and time to peak (TP) were measured with QontraXt software, and the index “relative enhancement percentage” ΔP% and “difference in TP between tumor and cortex” ΔTP were used to quantify the CEUS features of renal tumors. There are significant difference in CEUS features between the 46 clear cell renal cell carcinoma (CCRCC) and other types of renal tumors, including 17 low malignant lesions, 11 urothelial carcinoma of the renal pelvis, and 19 renal angiomyolipoma. The differences lie in the peak intensity, the homogeneity, the time of wash-in, peak, clearance and presence of pseudocapsule. The ΔTP and ΔP% of the CCRCC is significantly different from other tumors. With “fast to peak + high peak intensity” as the main criterion, assisted with “heterogeneous enhancement” and “fast wash-in” as the secondary criteria, the diagnostic accuracy of CCRCC is 91.4%, demonstrating quantitative CEUS imaging is highly valuable in differentiating CCRCC from other tumors.

Acoustic radiation force impulse (ARFI) ultrasound imaging technique is used to quantitatively evaluate the elasticity of rabbit VX2 liver tumor with alternated cooling and heating treatment (ACHT). ACHT was performed on fifteen VX2 liver tumor models established in fifteen male New Zealand white rabbits with open tumor plant. ARFI was performed on day 0, 1, 7 and 14 after ACHT and shear wave velocity (SWV) in ARFI was recorded to evaluate the elasticity of the treated area. The SWV value of the lesion on day 0, 1, 7 and 14 was 2.33 ± 0.19 m/s, 3.09 ± 0.40 m/s, 2.64 ± 0.37 m/s and 2.26 ± 0.24 m/s, respectively, indicating the treated areas get stiffer on day 1 and then get softer gradually by day. All the difference between adjacent time points was statistically significant. The SWV value of different parts on day 7 approved that the hardness of the treated area is heterogenous: the treated area in the center >the peripheral strip-shaped area >normal liver tissues, consistent with pathological changes. Meanwhile, ARFI combined with conventional US imaging can qualitatively and quantitatively exam the healing process of rabbit VX2 liver tumor after ACHT, and corresponds well to the pathological results.

To investigate the inter-rater reliability and agreement of the automated breast volume scanner (ABVS) and the diagnostic accuracy for differentiating malignant and benign lesions. The overall aim was to find out if the ABVS is applicable to daily clinical practice.

Inoperable liver tumors are often treated by thermal ablation that destroys the tumor in situ and spares the adjacent hepatic tissue. Thermal–physical treatment has many advantages, but treatment by freezing or heating alone has some limitations. By taking the advantages and disadvantages of cryosurgery and thermotherapy into consideration, a new thermal technique that combines cryosurgery and radio frequency ablation has been proposed, thereby overcoming the disadvantages of each treatment strategy and improving therapeutic outcomes. This new approach remains to be systematically studied in the liver; therefore, this study was performed to estimate survival after alternated cooling and heating ablation therapy in a VX2 rabbit liver tumor model. Sixteen days after VX2 carcinoma implantation into the rabbit liver, tumors were treated with alternated cooling and heating ablation therapy. Rabbits were monitored for 6 months after treatment and assessed with ultrasound (US) and computed tomography at 1, 7, 14, and 30 days posttreatment. Untreated tumor-bearing animals served as the control group. Our results show that alternate freezing and heating ablation therapy resulted in a good recovery of VX2 rabbits. Compared with the control group, treated rabbits lived significantly longer (P < 0.05), with 70 % of treated animals surviving to 196 days posttreatment without metastasis or recurrence, while none of the controls did so. There was no local recurrence in the treatment group. All rabbits in the control group developed metastasis, while metastasis was only observed in 30 % of treated rabbits. These results suggest that alternate cooling and heating ablation therapy can prolong the survival time of rabbits with VX2 liver tumors and is an effective method for tumor therapy. Furthermore, we also showed in this model that contrast enhanced US is a valid follow-up approach to assess treatment effectiveness.

Objective To explore the elasticity characteristics of renal malignant tumors with virtual touch tissue quantification(VTQ),and to evaluate its value on differential diagnosis of renal clear cell carcinoma(CCRCC).Methods VTQ was employed to detect the shear wave velocity(SWV)of 54renal malignant tumors and the surrounding normal renal cortex,in order to observe the elasticity of different types of malignant renal tumors,especially CCRCC of different sizes. Then the elasticity was compared among different types of malignant renal tumors with diameter less than 3cm,and ROC curve was used to evaluate the value of VTQ on differential diagnosis of CCRCC less than 3cm.Results No difference of SWV among tumors and normal cortex was found in 54renal malignant tumors(all P0.05),including CCRCC(n=40), chromophobe cell carcinoma(n=4),papillary renal cell carcinoma(n=3)and urothelial carcinoma(n=7).SWV of CCRCCs smaller than 3cm(n=13)was higher than that of surrounding cortex(P=0.01),andΔSWV(SWV difference between the tumor and the cortex)of CCRCC was higher than that of other types(P0.01).Taking△SWV≥0as the cut-off value to diagnose CCRCC less than 3cm,the area under the curve(AUC)was 0.897,the sensitivity,specificity and accuracy was 76.9%,91.7%and 84.6%,respectively.Conclusion There is no significant difference of elasticity between CCRCC,chromophobe cell carcinoma,papillary renal cell carcinoma,urothelial carcinoma and the surrounding cortex.CCRCC with diameter less than 3cm is stiffer than that of surrounding cortex and the other 3types of renal tumors. VTQ imaging shows medium diagnostic value for CCRCC smaller than 3cm.

The aim of the present study was to investigate the sonication effects of 21-kHz ultrasound (US) with microbubbles (MBs) on the subcutaneous prostate tumors of nude mice. In total, 15 tumor-bearing nude mice were divided into three groups: The control group, the low-frequency US group and the US+MB group. The MBs used were from US contrast agent SonoVue. The parameters of the US were as follows: 21 kHz, 26 mW/cm(2) and a 40% duty cycle (2 sec on, 3 sec off) for 3 min, once every other day for 2 weeks. Color Doppler flow imaging, hematoxylin and eosin (HE) staining, immunoblotting and transmission electron microscopy (TEM) were used to evaluate the results. Following 2 weeks of treatment, the blood flow signal disappeared in the US+MB group only, and the tumor size was smaller when compared with the control and US groups. For the immunoblotting, the intensity of cyclooxygenase-2 and vascular endothelial growth factor in the US+MB group was lower compared with the other two groups. Tumor necrosis was present and the nucleus disappeared upon HE staining in the US+MB group. Upon TEM analysis, increased cytoplasmic vacuolation and dilatation of the perinuclear cisternae of the tumor cells were found in the US+MB group. In the control and US groups, the tumors had intact vascular endothelia and vessel lumens. However, lumen occlusion of the vessels was observed in the US+MB group. In conclusion, 21-kHz low-intensity US with MBs may result in vessel occlusion and growth inhibitory effects in the subcutaneous tumors of nude mice.

目的 探讨正常兔肝冷热交替消融后消融灶的动态影像学和病理学变化.方法 对20只正常兔肝进行冷热交替消融.消融后1、3、7、14天行CT和CEUS,之后各处死5只兔,观察消融灶的病理学改变.结果 消融灶中心呈凝固性坏死.消融后7天内,坏死灶周围组织充血水肿和急性炎细胞浸润,CT平扫为低或等密度灶,常规超声为低回声为主的混合回声区;增强后均表现为无强化坏死灶和动脉期周边环状增强.消融后7～14天,坏死灶周围组织充血水肿好转,有纤维组织增生、慢性炎细胞浸润及钙化形成,表现为环形强化逐渐减轻消失,消融灶缩小.结论 冷热交替消融可在正常兔肝中产生凝固坏死灶;CT增强扫描和CEUS能有效反映不同时期肝脏消融灶的病理学变化,准确显示消融灶范围.

目的 应用声脉冲辐射力成像技术(ARFI)评价兔肝VX2肿瘤冷热交替治疗后的弹性变化.方法 选取9只新西兰大白兔,开腹种植肝VX2肿瘤共9枚,肿瘤生长第18天进行冷热交替治疗,术前及术后1、7、14 d分别应用ARFI技术进行检查,评价肿瘤消融后的弹性变化.结果 术后1d消融区较术前硬(P=0.003),术后7d与术后1d无显著差异(P=0.065),术后14 d较术后1d软(P=0.010).此外,术后7d病灶硬度不均一:中央消融区＞周边带状区＞外围正常肝组织,与病理相符.结论 ARFI技术能够定性、定量检测兔肝VX2肿瘤冷热交替治疗后不同时间的弹性变化,与病理改变相一致.

The aim of the present study was to investigate whether ultrasound treatment combined with microbubbles inhibits cell invasion and migration in androgen-independent prostate cancer (PCa) cells and to identify the probable mechanism. Ultrasound was used in continuous wave mode at a frequency of 21 kHz and with a spatial-average temporal-average intensity of 46 mW/cm2. Ultrasound combined with microbubbles (200 μl; SonoVue) was administered to androgen-independent human PCa PC-3 cells for 30 sec. The PC-3 cells were divided into three groups: The control group, the ultrasound group (US) and the ultrasound combined with microbubbles group (US + MB). Following treatment for 12, 24, 48 and 72 h, cell counting kit-8 was used to assess cell viability. Cell invasion and migration was measured 12 h after treatment using Transwell migration assays. Quantitative polymerase chain reaction and western blot analysis were used to evaluate the expression of the migration-associated proteins, matrix metalloproteinase (MMP)-2 and MMP-9. Cell reproduction levels in the US and US + MB groups were significantly suppressed when compared with the control group (P<0.01) following 24 h of treatment and this suppression was significantly higher in the US + MB group than in the US group (P<0.01). However, no significant differences in cell reproduction levels between the three groups were identified at 12 h (P>0.05). Ultrasound combined with microbubbles significantly suppressed the level of invasion and migration in the PC-3 cells compared with the control group (190.83±14.63 vs. 509.67±18.62, P<0.01; and 86.67±10.60 vs. 271.33±65.14; P<0.01, respectively). Furthermore, combined treatment with ultrasound and microbubbles suppressed the expression of MMP-2 and MMP-9. In conclusion, it was found that ultrasound combined with microbubbles suppressed invasion and migration in human PCa PC-3 cells via downregulation of MMP-2 and MMP-9.

Objective To evaluate the value of contrast enhanced ultrasonography(CEUS) differential diagnosis among different types of renal tumors. Methods 47 patients with 49 renal lesions who had undergone CEUS were retrospectively studied. All of the lesions were histopathologically or clinical proved. First, CEUS images were retrospectively analyzed consensus by 2 radiologists. The patterns, the intensity, the homogeneity of enhancement, the pseudocapsule were evaluated. Then, the Peak Intensity(P) and the time to Peak(TP)were measured with QontraXt, the index ΔP% and ΔTP were used when analysing quantitatively the CEUS features of renal tumors. At last, the diagnostic value of CEUS was evaluated renal tumors. Results There were significant difference between the 27 clear cell renal carcinoma(CCRCC) and the other types of renal tumors, including 4 low malignant lesions, 6 urothelium carcinoma of the renal pelvis, 12 renal angiomyolipoma(P0.05). The differences lie the intensity, the homogeneity, the time to and wash-in. The ΔP% of the CCRCC was higher than the other tumors(P0.05). Take fast to peak and high intensity as the main criteria, with heterogeneous enhancement and fast in as the secondary criteria and the diagnostic accuracy of CCRCC was 94%. Conclusion CEUS is highly valuable differentiating CCRCC from other tumors.

Objective To observe expression of microRNA(miRNA) in cardiac muscle tissues of advanced diabetic mice and to make an initial prediction of target gene regulated by difference miRNA. Methods Fifteen C57 mice were given single intraperitoneal injection of streptozotocin(STZ) to establish diabetic models(model group).Another 10 normal mice were as control group.At the end of 8 weeks after injection,left ventricular functions,including ejection fraction(EF),fractional shortening(FS),and left ventricular weight index(LVWI),were detected by using echocardiography.The mice were sacrificed for making cardiac muscle tissue samples.Then,cell morphology was observed by HE staining under optical microscope,and change of cell size was analyzed by quantitative software.Differential expressions of miRNA were performed with microarray analysis and further confirmed by quantitative real-time RT-PCR.The target gene regulated by difference miRNA was analyzed with bioinformatics. Results At the end of 8 weeks after injection,EF and FS in model group were significantly lower than those of control group,but LVWI significantly higher(P0.05).Under histological observation,cardiac hypertrophy showed obviously in model group.There were 16 microRNAs differential expressions detected by microarray analysis in model group,including 10 up-regulated(miR-195,miR-199a-3p,miR-700,miR-142-3p,miR-24,miR-21,miRNA-221,miR-499-3p,miR-208a,and miR-705) and 6 down-regulated(miR-29a,miR-1,miR-373,miR-143,miR-20a,and miR-220b).The bioinformatics analysis indicated that the target gene regulated by miRNA involved in cell proliferation,apoptosis,glycometabolism,and angiogenesis. Conclusion MiRNA expression profile in cardiac muscle tissues of STZ induced advanced diabetic mice has significantly changes,which may contribute toward the process of diabetic cardiomyopathy.

Diabetic vasculopathy is one of the major causes of death in patients with diabetes,which has complicate pathogenesis and is not yet clear.Studies showed that biological effects,such as polyol pathway,non-enzymatic glycation of proteins,hexosamine pathway,activation of protein kinase C,oxidative stress,and compensatory system,contribute to the occurrence and development of diabetic vasculopathy.The research progress of risk factors,pathophysiology,and molecular mechanism of occurrence of complications of macroangiopathy in diabetes is reviewed in this paper.