Objective To assess value and limitations of non-invasive methods in assessing liver fibrosis．Methods By summarized current situation and advancement of serum fibrotic markers, ultrasound, CT and MRI in assessing liver fibrosis, we investigated their value and limitations. Results In addition to diagnosis, non-invasive methods of assessing liver fibrosis assess severity of liver fibrosis. For liver fibrosis, however, non-invasive methods can not monitor effectively reaction to therapy and progression. Conclusion Non-invasive methods play important roles in diagnosis and assessing severity of liver fibrosis, and reduce the need of liver biopsy.
Objective To explore the value of virtual touch tissue quantification(VTQ) of acoustic radiation force impulse (ARFI) in the differential diagnosis between benign and malignant thyroid nodules. Methods The ultrasound (US), elastography imaging(EI), and VTQ of ARFI were performed to determine the characteristics and features of 63 thyroid nodules. The pathological diagnosis was the gold standard. According to the receiver operating characteristic curve (ROC) of US, EI, and VTQ, the critical points and diagnostic values of US, EI, and VTQ in diag-nosis of malignant thyroid nodules were achieved. Results Of the 63 nodules, 45 were benign and 18 were malignant. The area under curves of US, EI, and shear wave velocity(SWV) were 0.837(95% CI:0.712-0.962), 0.863(95% CI:0.751-0.974), and 0.900 (95% CI:0.810-0.990) respectively, and all the 3 kinds of technique had diagnostic value(P=0.001), but there were no significant difference among the 3 kinds of technique on the area under curve(P > 0.05). According to the receiver operating characteristic(ROC) curve, the critical point of US in distinguishing benign nodules with malignant nodules was 3 conventional ultrasonography, which displayed a sensitivity of 83.3%, a specificity of 86.7%, and a accuracy of 85.7%. The critical point of EI grades in distinguishing benign nodules with malignant nodules was gradeⅣ, which displayed a sensitivity of 94.1%, a specificity of 82.6%, and a accuracy of 87.3%. The critical value of SWV in distinguishing benign nodules with malignant nodules was 3.39 m/s, which displayed a sensiti-vity of 88.9%, a specificity of 91.1%, and a accuracy of 90.5%. Conclusion US, EI, and VTQ techniques all have diagnostic values in the differential diagnosis between benign and malignant thyroid nodules, and we should make combination with all of the 3 kinds of technique when performing differential diagnosis.
ObjectiveTo explore the effect of selective exercise training technique combined with ultrasound therapy on patellofemoral pain syndrome. MethodsPatients who met the research criteria were assigned into treatment group and control group randomly between July 2011 and August 2012. Each group had 28 patients. There were no significant differences in gender, age and body mass index between the two groups (P>0.05). Patients in the treatment group received selective exercise therapy and ultrasound therapy, while patients in the control group received normal exercise treatment and ultrasound therapy. Knee numerical pain rating scale (NPRS) and knee functional obstruction assessment were performed on all the patients before treatment and 5 days after treatment (on the 6th day) for comparison. ResultsBefore treatment, the score of NPRS in the treatment group and the control group was 4.7±0.8 and 4.8±0.9, respectively, with no significant difference (P>0.05). The score of functional obstruction assessment was 11.2±2.2 and 12.2±2.7 in the two groups without significant difference (P>0.05). Five days after treatment, the NPRS score decreased to 2.1±0.5 in the treatment group and 4.2±1.0 in the control group, and the knee functional obstruction assessment score decreased to 6.4±1.9 and 11.1±2.6, respectively. Both groups improved significantly in NPRS score and knee functional obstruction assessment score (P＜0.05), while the treatment group exhibited more improvement in the two scores than the control group (P＜0.05). ConclusionSelective exercise training is effective for improving the pain and function of patients with patellofemoral syndrome.
ObjectiveTo explore the diagnostic value of sonography in thyroid imaging reporting and data system (TI-RADS) for thyroid nodules. MethodsA total of 292 patients (423 nodules) underwent thyroid examination with high frequency ultrasound. The results were retrospectively compared with histopathological diagnosis and TI-RADS lexicon. ResultsThe category 1-5 of 423 thyroid nodules were evaluated by using TI-RADS, and it’s frequency of being malignancy rate was 0(0/129), 6.3%(11/176), 33.3%(10/30), 86.8%(46/53), and 100% (35/35), respectively. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for benign thyroid nodule of ultrasound in TI-RADS was 96.3%（309/321）, 83.3%（85/102）, 93.1%（394/423）, 94.8%（309/326）, and 87.6%（85/97）, respectively. Positive likelihood ratio, negative likelihood ratio, and Youden’ index was 5.77, 0.04, and 79.6%, respectively. The benign and malignancy nodule of TI-RADS category were statistically difference in shape, margin, echogenicity, echotexture, composition, and calcification inside the nodule (Plt;0.001). ConclusionsTI-RADS lexicon has an important guiding value for clinical diagnosis and treatment in ultrasound examination of thyroid nodule.
【Abstract】 Objective To review the study of noninvasive imaging methods for evaluating liver fibrosis. Methods The current literatures on the use of the ultrasonography， CT and MRI for the evaluation of liver fibrosis were reviewed. The principles, applications and advancement of each imaging methods were described and summarized respectively. The features of the newly developed imaging techniques were also discussed. Results In addition to the morphologic information， the imaging examinations can also provide functional information about the circulation status， diffusion and metabolism features of liver. The potential diagnostic value of MR elastography for liver fibrosis has been addressed. Conclusion The imaging examinations, especially the functional MRI techniques, are reliable noninvasive alternatives for the evaluation of hepatic fibrosis, with bright potentiality for clinical application.
Objective To compare the differences in the application of ultrasound scalpel and coagulation hook in thoracoscopic anterior mediastinal tumor surgery and to analyze the respective advantages and indications of the two commonly used energy instruments. Methods The clinical data of 85 patients undergoing thoracoscopic anterior mediastinal tumor surgery in West China Hospital of Sichuan University between June and November in 2017 were prospectively analyzed. There were 45 males and 40 females at age of 50.45 (18–75) years. The patients were divided into three groups including a ultrasound scalpel group (59 patients), a coagulation hook group (17 patients) and a mixed group (9 patients) according to the using time of energy devices. The clinical effect among the three groups were compared. Results No significant difference was found among the three groups in operation time, blood loss, average duration of chest tube drainage or volume of drainage (P>0.05). No significant complications occurred in all groups during operation or after operation. The proportion of subxiphoid approach in the ultrasound scalpel group was higher than that in the other two groups (49/59vs. 7/17 vs. 5/9, P<0.01). The maximum diameter of the tumor (4.58±2.19 cmvs. 4.05±1.07 cm vs. 3.00±1.45 cm, P<0.05) and the resected tissue weight (103.67±74.78 gvs. 61.17±31.97 g vs. 61.86±34.13 g, P<0.05) were also significantly greater than that in the coagulation hook group or the mixed group. Conclusion Ultrasound scalpel has good safety and reliability in the thoracoscopic anterior mediastinal tumor surgery, and is more suitable for operation in a narrow space.
ObjectiveTo investigate whether inferior vena cava (IVC) ultrasound can improve the success rate of weaning in patients with respiratory failure by comparing the difference of success rate between ultrasound-guided weaning mode and spontaneous breathing test (SBT) weaning mode.MethodsFrom November 2017 to May 2018, 31 respiratory failure patients underwent mechanical ventilation in intensive care unit were randomly divided into an ultrasonic guidance group (16 cases) and a control group (15 cases). All of them were offline after meeting the offline indications. The routine group was assessed by SBT for offline procedures. The diameter and variation rate of inferior vena cava were measured at SBT. IVC diameter >2.0 cm and variation rate < 50% were given intravenous diuretics. After the IVC diameter reached the standard again, the catheter was taken off the machine after passing SBT. The patients of both groups were considered as successfully weaned when they were able to tolerate at least 48 consecutive hours of spontaneous breathing. The following data were recorded at weaning, ie. Acute Physiological and Chronic Health Evaluation Ⅱ (APACHEⅡ) score, arterial blood gas analysis, plasma albumin, serum electrolyte sodium, potassium, 7-day and 14-day weaning success rate.ResultsThere were no significant differences in APACHEⅡ score, plasma albumin level, arterial oxygen partial pressure, carbon dioxide partial pressure, pH, blood sodium level or blood potassium level between the two groups at the beginning of weaning (all P>0.05), and the 2-day weaning success rate was higher in the ultrasound group than that in the control group (95% vs. 73%, P=0.039); the 7-day weaning success rate was higher in the ultrasound group than that in the control group (87% vs. 66%, P=0.043). No significant difference was found in the 14-day weaning success rate (68% in the ultrasound group vs. 53% in the control group, P=0.446).ConclusionUltrasound can improve the success rate of weaning in patients with respiratory failure.
Objective To determine the value of contrast-enhanced ultrasound (CEUS) in the differentiation of primary liver cancer (PLC) and hepatic alveolar echinococcosis (HAE). Methods The data of 56 patients with PLC or HAE were collected between January 2010 and May 2015. Grayscale and CEUS features of the patients were analyzed retrospectively. The frequency of each imaging finding, including calcification, arterial enhancement, and internal enhancement were evaluated and compared. Results Statistically significant difference of the proportion of gender and age were detected between the two groups (P=0.013, 0.002). Thirty-eight PLC lesions were detected in 32 patients. The diameters of PLC lesions were 3-10 cm with an average of (5.6±2.1) cm. Thirty-two HAE lesions were found in 24 patients. The diameters of HAE lesions were 4-12 cm with an average of (9.1±4.4) cm. Statistically significant difference of lesion size and the incidence rate of calcification (5.3% vs. 75.0%) were seen between PLC and HAE (P<0.001). Peripheral enhancement were seen in 100.0% (38/38) PLC lesions, including 84.2% (32/38) hyperenhancement and 15.8% (6/38) dendritic hyperenhancement. All PLC lesions demonstrated hypoenhancement in late phase. Irregular peripherally hyperenhancement both in arterial and late phase were detected in 43.8% (14/32) HAE lesions. The other 56.2% (18/32) HAE lesions showed no peripheral enhancement both in arterial and late phase. No internal enhancement were seen in HAE lesions. The presence of arterial enhancement (100.0% vs. 43.8%) and absence of internal enhancement (0 vs. 100.0%) were significantly different between PLC and HAE (P<0.001). Conclusions PLC is predicted by arterial phase hyperenhancement and late phase hypoenhancement on CEUS. HAE is predicted with calcification on baseline sonography and internal non-enhancement on CEUS. Arterial phase enhancement is less common and less intensive in HAE than in PLC which also contributes to the differentiation of these lesions.
ObjectiveTo explore the differences in ultrasonographic features of testicular teratoma and yolk sac tumor (YST) in children.MethodsA total of 44 patients were selected, including 30 with testicular teratoma and 14 with YST, whose diagnoses were confirmed by surgery and pathology in West China Second University Hospital, Sichuan University from January 2015 to June 2019. The differences in ultrasonograhic characteristics of the two groups were compared, such as the size, location, internal echo, composition, and blood supply of the tumors.ResultsThe mean value of maximum diameters of testicular teratomas was (24.25±12.13) mm and that of YSTs was (29.71±18.75) mm, with no statistically significant difference between the two groups (F=0.531, P=0.383). In terms of the compositions of the tumors, cystic-solid lesions were the most common in testicular teratomas (17/30), followed by solid lesions (8/30) and cystic lesions (5/30); while solid lesions were the most common in YSTs (12/14), followed by cystic-solid lesions, and cystic lesions did not appear. The difference in the compositions of tumors was statistically significant between children’s testicular teratomas and YSTs (P=0.001), especially in the proportion of solid lesions. In terms of Adler grade of blood flow, there were 9 cases of Adler 0, 10 cases of Adler 1, 10 cases of Adler 2, and 1 case of Adler 3 in testicular teratomas, while there were 0 case of Adler 0, 1 case of Adler 1, 4 cases of Adler 2, and 9 cases of Adler 3 in YSTs. The difference in the blood supply was statistically significant between children’s testicular teratomas and YSTs (P<0.001). Testicular teratomas tended less to behave as Adler 3, while Adler 3 was the most common in YSTs. There was no statistically significant difference in other ultrasonic features, like the location, internal echo, or the existence of calcification (P>0.05).ConclusionsUltrasound has a certain meaning for the differential diagnosis of testicular teratoma and YST in children. By comparing the solid component and the blood supply of the tumor, it is helpful for enhancing the diagnostic confidence of sonographer.
Objective To evaluate the sensitivity， specificity, and accuracy of magnetic resonance imaging （MRI） in characterizing adnexal masses. Methods The databases such as the Cochrane Library, PubMed， EMbase， CNKI， and WanFang Data were searched on computer from 1991 to 2011. The reviewers screened the trials according to inclusion and exclusion criteria strictly, extracted the data， and assessed the methodology quality. Meta-analysis were performed using the Metadisc 1.40 software. The acquired pooled sensitivity, specificity， and summary receiver operating characteristic curve （SROC） were used to describe the diagnostic value. The pooled likelihood ratios were calculated based on the pooled sensitivity and specificity. Results Ten case-control studies involving 649 women who were suspected to have pelvic masses were included and 729 masses were confirmed by the postoperative histopathology. The pooled statistical results of meta-analysis showed that：the sensitivity and specificity of MRI were 〔89%（84%-92%）， P=0.046 6〕 and 〔87% （83%-90%）， P=0.000 2〕 respectively, the positive and negative likelihood ratios of MRI were 6.25（P=0.008 5） and 0.14（P=0.029 1） respectively, and the area under the SROC curve （AUC） was 0.941. The sensitivity and specificity of ultrasound were 〔87%（82%-91%）， P=0.000 0〕 and 〔73%（69%-77%）, P=0.000 0〕 respectively, the positive and negative likelihood ratios of MRI were 3.07（P=0.000 0） and 0.18（P=0.000 1） respectively， and the AUC was 0.897. The speci?city and accuracy of MRI in characterizing female pelvic masses were higher than ultrasound obviously. Conclusion According these evidences， the MRI should be recommended to the women who are suspected to have pelvic masses as a preferred.