ObjectiveTo study the Young's modulus obtained by the real-time shear wave elastography (SWE) in healthy adults' parotid gland and submaxillary gland and to explore the probable factors affecting the Young's modulus, such as bilateral parotid and submaxillary gland, sex, age, height and weight. MethodsThere were 35 healthy volunteers who underwent SWE in parotid gland and submaxillary gland between December 3 and 18, 2013. The difference of Young's modulus in bilateral parotid and submaxillary gland, and the modulus values of different sex, age, height and weight groups were also compared. ResultsThe Young's modulus of parotid gland was (8.14±1.78) kPa, and the Young's modulus of submaxillary gland was (11.52±2.34) kPa. The differences of Young's modulus between the two sides of parotid gland and submaxillary gland were not statistically significant (P>0.05); the differences of Young's modulus of parotid and submaxillary gland between different sex, age, height and weight groups had no statistical significance, either (P>0.05). ConclusionThe real-time shear wave elastography can be applied to evaluate the elasticity of parotid and submaxillary gland and to lay the foundation for further diagnosis of salivary lesions.
Objective To understand and analyze technique development of magnetic resonance elastography (MRE) and its application in chronic liver disease. Method The relevant literatures about the application of MRE in the field of chronic liver disease were reviewed. Results The liver fibrosis was a common pathway of chronic liver disease, which would progress to cirrhosis of the liver if untreated. The diagnosis and assessment of fibrosis was important in the treatment of patients with chronic liver disease. The liver biopsy was considered to be the reference standard for clinical assessment of liver fibrosis. However, this technique was invasive and still had inevitable drawbacks in the clinical practice. With the update of the imaging technology and equipment, the MRE had been developed as a safe and noninvasive examination method for the evaluation of liver fibrosis in the chronic liver disease, early diagnosis of nonalcoholic fatty liver disease, evaluation of focal liver lesions, and other clinical applications. Conclusion MRE is currently regarded as an attractive noninvasive technique in management of chronic liver disease.
Objective To investigate the diagnostic value of strain elastography (SE) and virtual touch tissue image quantification (VTIQ) technique in determining the nature of cervical lymph nodes in patients with lung cancer. Methods A total of 124 patients with lung cancer combined with cervical lymph node enlargement were selected for this study. All patients underwent routine ultrasound examination, using SE to detect lymph nodes and scored them, and using VTIQ technique fro measurement of lymph node shear wave velocity (SWV). Pathological results were taken as gold standards. Non-metastatic lymph nodes were included in the benign group, while metastatic lymph nodes were included in the malignant group. Receiver operating characteristic (ROC) curve was generated. The optimal cutoff value of SWV was determined for predicting metastatic lymph nodes, the area under curve (AUC) of SE and VTIQ technique was compared, and the diagnostic efficacy of SE and VTIQ technique for benign and malignant lymph nodes was analyzed. Results Among the 124 patients, 28 cases of benign lymph nodes had an SE score of 2 - 3, and 59 cases of malignant lymph nodes had an SE score of 4 - 5. The accuracy, sensitivity, and specificity of SE were 70.2%, 75.6%, and 60.9%, respectively. The maximum, minimum, median, and mean values of SWV in the malignant lymph nodes were significantly higher than those in the benign lymph nodes in VTIQ technique testing (P<0.05). Based on the ROC curve analysis, the mean value of SWV had the highest diagnostic efficiency, and its cutoff value of 3.18 m/s was used as the diagnostic criterion for predicting malignant lymph nodes. The accuracy, sensitivity, and specificity of the VTIQ technique in diagnosing malignant lymph nodes were 85.5%, 92.3%, and 73.9%, respectively. The AUC of SE and VTIQ technique were 0.713 and 0.896, respectively, indicating higher diagnostic value of VTIQ technique. Conclusions Both SE and VTIQ technique have high accuracy in determining the nature of cervical lymph nodes in lung cancer patients. Compared with SE, VTIQ technique showed superior diagnostic performance, and SWVmean has the best diagnostic performance. It can provide a new non-invasive examination method for evaluating the nature of cervical lymph nodes in lung cancer patients in clinical practice.
ObjectiveTo evaluate the changes in thrombelastography(TEG) during orthotopic liver transplantation （OLT） in Chinese. MethodsTwentyfive patients with cirrhosis of liver undergoing OLT were studied. They were composed of two groups: cirrhosis group （n=15） and liver neoplasm group （n=10）. Anesthesia was induced with propofol 1.5-2 mg/kg,fentanyl 3-5 μg/kg and vecuronium 0.1 mg/kg and maintained with isoflurane or enflurane inhalation.The operation was divided into three phases: ① before operation and preanhepatic phase （120 min after operation was started）, ② 30 min after liver was removed,③ 5 min before reperfusion and 5 min,15 min,30 min,60 min and 120 min after reperfusion.In 8 patients among the 25 patients heparinasecelite TEG was measured 5 min after reperfusion in addition to celite TEG.If there was significant differences in traces between the two TEG measurements,an intravenous bolus of 50-75 mg protamine was given and the heparinasecelite TEG was repeated.The measured variables included the r （reaction） time,representing the rate of initial fibrin formation K （coagulation） time, alpha angles （α） reflecting fibrinplatelet interaction, MA （maximal amplitude） indicating qualitative platelet function and percent fibrinolysis at 60 min. ResultsIn cirrhosis group changes in TEG occurred after liver was removed and in earlier period after reperfusion, while in liver neoplasm group changes in TEG were found in earlier period after reperfusion as compared with preoperative value.At 5 min after reperfusion there were significant differences in TEG （r，K，α and MA） values between celite and heparincelite TEG （P＜0.01）. ConclusionDuring OLT coagulation disorder occurs mainly at anhepatic and early reperfusion phase.
Objective To explore the application value of shear wave elastography (SWE) combined with diaphragmatic thickening fraction (DTF) and rapid shallow breathing index (RSBI) in predicting the results of weaning of patients with mechanical ventilation. Methods Fifty-two patients with severe illness who were hospitalized in this hospital from January 2022 to September 2022 were treated with mechanical ventilation. After meeting the conditions for weaning, they underwent spontaneous breathing test, and the diaphragm function of patients was evaluated by measuring DTF using ultrasound technology and shear modulus (SM) using SWE technology. According to the weaning results, they were divided into weaning success group and weaning failure group, The differences of mechanical ventilation time, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, respiratory rate, RSBI, oxygenation index, DTF, SM and other parameters between the two groups were compared. Multivariate logistic regression was used to analyze the factors affecting the withdrawal results. The receiver operator characteristic (ROC) curve was used to evaluate the predictive value of potential influencing factors on the withdrawal results. Results There were 39 cases of successful withdrawal and 13 cases of failure. There were significant differences in mechanical ventilation time, respiratory rate, RSBI, DTF and SM between the successful weaning group and the failure group (P<0.05). Through multivariate logistic regression analysis, RSBI [area under the ROC curve (AUC)=0.771, 95% confidence interval (CI) 0.589 - 0.953], DTF (AUC=0.806, 95%CI 0.661 - 0.951), SM (AUC=0.838, 95%CI 0.695 - 0.981) were independent factors that affected the results of withdrawal. The single parameter AUC was smaller than the combined index with RSBI≤70.48 times·min–1L–1, DTF≥30.0%, SM≥10.0 kPa as the cutoff value (AUC=0.937, 95%CI 0.714 - 1.0, diagnostic sensitivity, specificity and accuracy were 94.9%, 84.6% and 92.3% respectively). Conclusions SWE technology provides a new quantitative index for evaluating diaphragm function by evaluating diaphragm stiffness. Diaphragm stiffness combined with DTF and RSBI can better predict the successful withdrawal in patients with mechanical ventilation.
ObjectiveTo explore the value of ultrasound real-time tissue elastography in the differential diagnosis between benign and malignant breast lesions.Methods A total of 131 cases of patients with breast lesions who underwent ultrasound examination in the People’s Hospital of Guangan City between December 2010 and December 2015 were enrolled as the research object. The patients took conventional color Doppler ultrasound diagnosis firstly, and then took ultrasound real-time tissue elastography diagnosis. The lesions were scored with improved 5-scoring system respectively. By the strain ratio measure method equipped with the ultrasonic machine, strain ratio of the lesion was calculated, with 3.08 as the cut-off pont. The results were campared with the pathologic diagnosis.ResultsThere were 182 breast lumps in the 131 patients. The conventional ultrasound examination detected 128 benign lesions and 54 malignant lesions. By ultrasound real-time tissue elastography examination, there were 121 benign tumors and 61 malignant tumors. For the benign tumors, the elasticity imaging score was 1.74±0.81, and the elastic strain rate ratio was 1.83±1.22; for the malignant tumors, the elasticity imaging score was 4.45±0.59, and the elastic strain rate ratio was 8.68±5.58. The 182 breast lumps were all removed by surgical resection, and the pathologic examination showed there were 121 benign lesions and 61 malignant lesions. The accuracy, sensitivity and specificity of conventional ultrasonic diagnosis of breast malignant lesions was 76.4%, 59.0% and 85.1%, respectively; while the indexes of ultrasound real-time tissue elastography diagnosis of breast malignant lesions was 96.7%, 95.1% and 97.5%, respectively, and the differences were statistically significant (P<0.05).ConclusionReal-time tissue elastography is helpful in the differential diagnosis between malignant and benign breast lesions.
Objective To evaluate the security and validity of the acute extreme hypervolemic hemodilution (AEHH) in spine surgery. Methods Thirteen patients(8 males, 5 females; age, 16-65 years; weight, 50-75 kg) who had undergone major spine operations were enrolled in this study. Eleven of them had undergone anterior decompression, who were given the grafting and the internal fixation for their thoracolumber spinal burst fractures; the other 2 patients were given the correction operation for their scoliosis. The baselines of the haematocrit (Hct）were 0.363-0.481 before operation. The patients had no cardiac, pulmonary, hepatic or renal dysfunction or coagulation abnormality. The hemodynamic status and the haematocrit were observed during operation. The parameters of thromboelastography (TEG)，arterial blood gas, and electrolytes were measured and observed at the following time points: before AEHH, after AEHH, 60 minutes after AEHH, 120 minutes after AEHH, and the end of the operation. The total fluid volume was recorded. Results The autologous blood volume was1 050-1 575 ml (average,1 419±198 ml), plasma substitute 2 100-3 150 ml (average,2 838±397 ml), blood loss1 000-3 130 ml (average, 1 747±743 ml), urine 450-1 270 ml (average, 871±374 ml), and the net blood transfusion 1 206-2 661 ml(1 863±598 ml). The homogenous blood of 400 ml was transfused in 1 patient for making upthe blood loss of 3 130 ml. There were no statistically significant differencesin the hemodynamic measurements, arterial blood gas, and electrolyte variables when compared with the baseline values before the hemodilution (Pgt;0.05). The reaction time of TEG was longer 60 minutes after AEHH than before AEHH (Plt;0.05); the other parameters of TEG had no differences when compared with the baseline values (Pgt;0.05). Conclusion The AEHH is safe and efficient in reduction of the perioperative homogenous blood transfusion in spine surgery.
ObjectiveTo explore value of ultrasound real-time elastography (RTE) technology for identification of benign and malignant solid thyroid nodules.MethodsA retrospective analysis was performed on 125 patients with thyroid nodules who underwent ultrasound RTE in this hospital from February 2018 to August 2019. All patients underwent RTE on the basis of conventional ultrasound. The ultrasound elasticity contrast index (ECI) was used as the evaluation index and the pathological examination result was used as the gold standard. The receiver operating characteristic (ROC) curve analysis was used to evaluate the value of ECI in the identification of benign and malignant solid thyroid nodules. Logistic regression analysis was used to analyze the influencing factors of ECI.ResultsAmong the 125 patients with solid thyroid nodules, 51 were malignant nodules, 74 were benign nodules. The ECI value of patients with benign thyroid nodules was lower than that of patients with malignant nodules (2.71±0.83 versus 3.42±1.14, t=–4.030, P<0.001). The result of ROC analysis showed that the cutoff value of ECI to distinguish benign and malignant solid thyroid nodules was 3.07, area under curve of ROC was 0.806 [95%CI (0.717, 0.894), P<0.001], sensitivity was 80.3%, specificity was 70.4%. The multivariate logistic regression analysis showed that the thyroid nodules with diffuse lesions, calcification, and maximum nodule diameter ≥1 cm were the risk factors for elevated ECI values (P<0.05). For the solid thyroid nodules without diffuse lesions, without calcification, and maximum nodule diameter <1 cm, ECI had the higher sensitivity, specificity, accuracy, and positive predictive value for the differential diagnosis of benign and malignant thyroid nodules (all exceed 80%), but these indexes were lower (under 60%) for the differential diagnosis of solid thyroid nodules with diffuse diseases, with calcification, and maximum nodule diameter ≥1 cm.ConclusionsECI obtained by ultrasound RTE can be used to differentiate solid thyroid nodules from benign ones. The presence or absence of diffuse lesions, calcification, and maximum nodule diameter are the influencing factors for ECI to differentiate solid thyroid nodules. In clinical diagnosis, it should be paid attention to the comprehensive analysis of the above factors.
ObjectiveTo investigate the influence of 6% hydroxyethyl starch (HES, 130/0.4)on blood coagulation of patients after off-pump coronary artery bypass grafting (opCAB)by thromboelastography (TEG). MethodsOne hundred patients undergoing elective opCAB in Department of Cardiovascular Surgery, General Hospital of Shenyang Military Area Command between May and July 2013 were enrolled in this study. All the patients were randomly divided into 2 groups using random number table method with 50 patients in each group. In the experimental group (G1 group), there were 27 males and 23 females with their age of 64.9±4.4 years, who received intravenous 6% HES (130/0.4)20 ml/kg in 4 hours postoperatively. In the control group (G2 group), there were 31 males and 19 females with their age of 63.1±5.8 years, who received intravenous lactated ringers 20 ml/kg in 4 hours postoperatively. After postoperative ICU admission, full blood count, coagulation tests and TEG were examined. Chest and mediastinal drainage was recorded at 6 hours and 24 hours postoperatively. ResultsThere was no statistical difference in chest and mediastinal drainage 24 hours postoperatively between the 2 groups (591.7±171.7 ml vs. 542.4±174.0 ml, P > 0.05). None of the patients received reexploration for bleeding. There was no statistical difference in hemoglobin, hematocrit, platelet count or traditional coagulation index between the 2 groups (P > 0.05). TEG showed no significant change in coagulation time after intravenous fluid infusion in either group. Reaction time was slightly extended in both groups, but there was no statistical difference in reaction time between the 2 groups (P > 0.05). Maximum amplitude (MA)of G1 group was significantly decreased after intravenous fluid infusion (55.9±10.0 mm vs. 62.8±7.9 mm, P < 0.05), but still within the normal range. There was no significant change in MA after intravenous fluid infusion in G2 group. ConclusionIntravenous infusion of 6% HES (130/0.4)20 ml/kg can reduce platelet function and clot strength, but does not significantly increase postoperative chest or mediastinal drainage, or the incidence of postoperative reexploration for bleeding. It's safe to administer 6% HES (130/0.4)for patients after OPCAB.
Objective To compare differences of characteristics of ultrasonic elasticity imaging for benign and malignant small thyroid nodules with or without Hashimoto thyroiditis (HT). Methods The thyroid nodules with ≤1 cm size and the category 4A, 4B, 4C, and 5 of Thyroid Imaging Reporting and Data System (TI-RADS) were included into this study, and a further examination of real-time elastography was performed. The final diagnosis was relied on the pathological diagnosis. The elasticity score and strain ratio (SR) were recorded and compared between these two groups, respectively. Results Of the 424 nodules, 103 nodules were accompanied with HT (thyroid nodule with HT group), 321 nodules were not accompanied with HT (thyroid nodule without HT group). In the thyroid nodule with HT group, the area under the receiver operator characteristic (ROC) curve (AUCs) of the elasticity score and the SR was 0.685 and 0.676, respectively; the optimal cut offs of the elasticity score and the SR was 3 points and 2.45 respectively, their corresponding sensitivity, specificity, and accuracy was 75.7%, 57.6%, 68.0% and 75.7%, 60.6%, 67.6%, respectively. In the thyroid nodule without HT group, the AUCs of the elasticity score and the SR was 0.692 and 0.692, respectively; the optimal cut offs of the elasticity score and the SR was 4 points and 2.84, respectively; their corresponding sensitivity, specificity, and accuracy was 57.5%, 74.2%, 69.2% and 76.1%, 59.7%, 67.7%, respectively. Conclusions Elastography is helpful in differential diagnosis of benign and malignant small thyroid nodules. While, standards of elasticity score and SR value in differential diagnosis are different between benign and malignant small thyroid nodules with HT and without HT, elasticity score and SR ratio decrease in benign and malignant small thyroid nodules with HT.