【Abstract】ObjectiveTo evaluate the role of MRA, IPVG and DUS in the hemodynamics studies of portal hypertension. MethodsThirtyeight patients with portal hypertension were examined with Philips Gyroscan 1.0 Tesla MR imaging system. 3DDCE MRA and 2DPC MR were used for study of portal venous anatomy and its hemodynamics. The results were compared with those obtained from IPVG and DUS. Results3DDCE MRA could clearly display the anatomical imaging of portal venous system and its imaging quality was better than that of IPVG. The data of hemodynamics from 2DPC MR including diameter, blood velocity and blood flow were closely correlated to those from DUS. ConclusionAs a noninvasive technique, MRA can display the anatomy of portal venous system and measure its hemodynamics exactly. It should be applied as the first choice in hemodynamics evaluation for portal hypertension.
ObjectiveTo evaluate the value of high-frequency color Doppler ultrasonography in the diagnosis of femoral hernia. MethodsThe ultrasonographic features of 39 femoral hernias in 37 patients treated between March 2008 and October 2013 were retrospectively analyzed, and the results were confirmed by surgery. ResultsThirty-nine femoral hernias were diagnosed by surgery, including 19 in the right side, 16 in the left side, and 2 with double-side hernias. Thirty-seven femoral hernias were diagnosed with ultrasonography. Two femoral hernias were misdiagnosed as lipoma in one, and as enlarged lymph nodes in one, respectively. Ultrasound diagnosis accurate rate was 94.9% (37/39). Hernia content could be seen through surgery in 28 cases, and the ultrasound accurate rate in assessing the hernia content was 85.7% (24/28). ConclusionUltrasonography is the first choice for improving the diagnosis efficacy of femoral hernia.
Objective To explore the effectiveness of arterial crisis after replantation of limb treated by ultrasound guided Fogarty balloon catheter. Methods Between January 2012 and July 2016, 27 patients suffered from arterial crisis after replantation of limb were treated with ultrasound guided Fogarty balloon catheter combined with thrombolytic anticoagulant. There were 18 males and 9 females with the age of 19-51 years (mean, 32 years). The limb mutilation position was at knee joint in 3 cases, lower limb in 9 cases, ankle joint in 6 cases, elbow joint in 2 cases, forearm in 4 cases, and wrist joint in 3 cases. The arterial crisis happened at 2.5-18 hours (mean, 7.5 hours) after limb replantation surgery. Color doppler ultrasonography was used to diagnose the arterial thrombosis, finally the anastomotic thrombosis were found in 16 cases, non-anastomotic thrombosis in 7 cases, and combined thrombosis in 4 cases. All the thrombosis were deteced in the arteries with the length of 0.8-3.9 cm. Results No complication such as vascular perforation, rupture, air embolism, thromboembolism, wound infection, or sepsis happened after operation. Arterial crisis occurred again in 3 cases at 1.5-13.5 hours after limb replantation and treated by arterial exploration, 1 case was treated successfully; 2 cases had arterial occlusion and partial necrosis of limb, and got amputation treatment at last. The rest 24 cases survived with the incision healing by first stage. In the 24 cases, 1 case suffered from acute myonephropathic metabolic syndrome and corrected after hemodialysis; 1 case suffered from acute liver functional damage and corrected by comprehensive treatment of internal medicine. The 24 patients were followed up 7-38 months (mean, 11 months). At last follow-up, blood supply of the limb was good with normal skin temperature and improved sense of feeling, activity, and swelling. According to Chinese Medical Association of hand surgery to the upper extremity function assessment standard, the results were excellent in 12 cases, good in 8 cases, and fair in 4 cases with an excellent and good rate of 83.3%. Conclusion Ultrasound guided Fogarty balloon catheter treatment of posterior replantation of arterial crisis can accurately locate the thrombosis, get the thrombus fast and invasive minimally to avoid the blind and repeated thrombectomy, and obtain certain effectiveness.
Objective To explore the characteristics and diagnostic values of ultrasound examination of retinoblastoma (RB).Methods The ultrasound and CT features of 210 eyes (162 patients) with pathologically confirmed RB were analyzed retrospectively. Results The ultrasonography image of those RB eyes were all characterized by substantial masses in the posterior segment of the eyeball, shown as spherical, hemispherical and irregular in shape, and even filled the entire eyeball. Calcification within the mass was observed in 197 eyes of 149 patients (92.0%), but not observed in 13 eyes of 13 patients (8.0%).Colorful blood flow signals extended from the central retinal vessels could be seen inside the masses of all patients. Ultrasound diagnosis was consistent with the pathological diagnosis in 92.0% RB cases. CT examination revealed calcified speckles or plaques in 167 eyes from 145 patients (89.5%), consistent with the pathological diagnosis of RB.Conclusions Ultrasonography can show the tumorprime;s shape, size, internal features and the range of orbital involvement. It is a valuable clinical tool in the diagnosis of RB.
ObjectiveTo analyze the color Doppler flow imaging (CDFI) features of familial exudative vitreoretinopathy (FEVR) at different stages. MethodsA retrospective study. A total of 104 patients with 201 eyes from Department of Ophthalmology of Beijing Tongren Hospital who were hospitalized for fundus examination and diagnosed with FEVR from 2018 to 2022 were included. There were 69 male cases with 133 eyes and 35 female cases with 68 eyes. The age was ranged from 2 months to 11 years, with a mean age of 2.9 years. Fundus and CDFI examination were performed in both eyes. Fluorescein fundus angiography was performed in 72 cases (144 eyes). FEVR staging was conducted according to literature standards. The presence of avascular areas in the peripheral retina or abnormal retina neovascularization was stage 1; the presence of retinal neovascularization at the vitreoretinal interface in the avascular area was stage 2; partial retinal detachment without macula involvement was stage 3; partial retinal detachment involving the macula was stage 4; complete retinal detachment was stage 5. The CDFI ultrasound features of FEVR at different stages were analyzed. The CDFI image features of FEVR patients in different stages were observed. ResultsAmong the 104 patients, 97 (93.3%, 97/104) cases were binocular and 7 (6.7%, 7/104) cases were monocular. In 201 eyes, stages 1 to 5 of FEVR were 49 (24.4%, 49/201), 23 (11.4%, 23/201), 39 (19.4%, 39/201), 71 (35.3%, 71/201), and 19 (9.5%, 19/201) eyes, respectively. CDFI examination showed no abnormality or mild vitreous opacity in 49 eyes vitreous body at stage 1. Vitreous opacities were observed in all 23 eyes in stage 2, and the echo of the temporal ballwall was not smooth. In 39 eyes at stage 3, the anterior globular cluster echo in temporal peripheral eyes was observed in 17 eyes and partial retinal detachment was observed in 13 eyes. In 71 eyes at stage 4, 51 eyes had temporal or infratemporal retinal folds, and 20 eyes had temporal retinal detachment. All the 19 eyes in stage 5 had total retinal detachment, of which 15 eyes had closed "funnel-shaped" retinal detachment. Among the patients with retinal folds, 13 had bilateral folds, and the fellow eyes of the other 25 patients with unilateral folds all had vitreous opacity or clump echo in front of the temporal spherical wall. Blood flow signals could be detected on the retinal folds with Doppler imaging. ConclusionsThe CDFI manifestations of FEVR patients at different stages have different characteristics. The possibility of FEVR should be considered when the temporal or infratemporal retinal folds of both eyes are present, as well as the retinal folds of one eye, the contralateral vitreous body opacity, or the anterior temporal peribulbar cluster echoes are present.
ObjectiveTo evaluate the application of dexmedetomidine for moderate sedation in patients undergoing endoscopic ultrasonography.MethodsPatients who were planned to undergo endoscopic ultrasonography in West China Hospital of Sichuan University from February to June 2019 were randomly divided into dexmedetomidine group (trial group) and propofol group (control group). The basic conditions, success rate of endoscopic ultrasound diagnosis and treatment, sedation-related adverse events, implementation of airway management, postoperative comfort evaluation and endoscopic physician satisfaction score of the two groups were compared.ResultsA total of 120 patients were eventually enrolled, 60 in each group. There was no significant difference in the basic conditions of the two groups (P>0.05). The success rate of endoscopic ultrasound diagnosis and treatment in two groups were 100%. There was no significant difference in the incidence of bucking, apnea and bradycardia between the two groups (P>0.05). The incidence of hypotension (15.0% vs. 31.7%), hypoxemia (6.7% vs.20.0%) in the trial group was lower than those in the control group, the differences were statistically significant (P<0.05). The proportion of patients in the trial group who performed airway management was lower than that in the control group (1.7% vs. 28.3%), and the difference was statistically significant (P<0.05). There was no significant difference in postoperative pain score, the first time to get out of bed and postoperative 15-item quality of recovery questionnaire score between the two groups (P>0.05). The incidence of nausea and vomiting at 6 hours after operation (48.3% vs. 3.3%) and 24 hours after operation (10.0% vs. 0.0%) and the time required for recovery of gastrointestinal function ［(201.4±178.4) vs. (148.5±75.7) min］ in the trial group were higher than those in the control group (P<0.05). The median (the lower and upper quartile) of comfort score of patients and satisfaction score of endoscopic physicians were 8 (6, 10) and 8 (7, 9) in the trial group, respectively, and were 10 (9, 10) and 9 (8, 10) in the control group, with statistically significant differences (P<0.05).ConclusionModerate sedation with dexmedetomidine could provide good sedative and analgesic effects in endoscopic ultrasonography. It has little effect on respiration and blood pressure, but the incidence of postoperative nausea and vomiting were higher than deep sedation with propofol. And patient comfort and endoscopic physician satisfaction also need to be improved.
ObjectiveTo observe the hemodynamic parameters of retrobulbar vessels of eyes with primary open-angle glaucoma (POAG) by using color Doppler imaging (CDI) technique. Methods Pertinent publications were retrieved from the PubMed of The National Library of Medicine, the ISI Web of Knowledge of The Institute for Scientific Information, and Cochrane Central Register of Controlled Trials. Case control studies involved POAG patients were included. Changes in retrobulbar blood flow parameters including peak systolic velocity (PSV), end diastolic velocity (EDV) and resistive index (RI) of the ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary artery (SPCA) were evaluated by CDI. The searching time was from the data base established up to April, 2014. Meta analysis was used on the included articles, the mean difference (MD) along with 95% confidence interval (95% CI) of the blood flow parameters were calculated. ResultsTwenty-four articles were retrieved, including 1336 eyes as cases, 1102 eyes as controls. PSV of POAG eyes was statistically signiflcantly lower than controls in the OA (MD=-3.05, 95%CI:-4.49--1.61, P < 0.001), CRA (MD=-1.66, 95%CI:-1.95--1.38, P < 0.001), SPCA (MD=-0.87, 95% CI:-1.49--0.26, P=0.005). EDV of POAG eyes was statistically significantly reduced than controls in the OA (MD=-1.78, 95%CI:-2.14--1.41, P < 0.001), CRA (MD=-0.95, 95%CI:-1.17--0.74, P < 0.001), SPCA (MD=-0.53, 95%CI:-0.71--0.36, P < 0.001). Statistically significant increases in RI of POAG eyes than controls in the OA (MD=0.04, 95%CI: 0.03-0.05, P < 0.001), CRA (MD=0.06, 95%CI: 0.05-0.07, P < 0.001), SPCA (MD=0.04, 95%CI: 0.03-0.06, P < 0.001). ConclusionThis meta-analysis suggests that significant decreased velocity and increased resistance of retrobulbar blood flow are found in POAG eyes.
Objective To summarize ultrasonography, CT and (or) MRI imaging features of cystic liver lesions so as to improve its diagnostic accuracy. Methods The literatures relevant imaging studies of different types of cystic liver lesions at home and abroad were searched. Then with the etiology as clue, the imaging fetures of ultrasonography, CT and (or) MRI plain scan and enhancement scan were summarized. Results The cystic liver lesions had many types, their imaging findings were different and existed overlaps. The diagnosis and differential diagnosis of atypical cases were difficult. ① For the simple hepatic cyst, it was a round cystic mass with water-like echo, density and signal. The boundary was clear, and there was no separation in the cyst, without contrast enhancement. The sensitivity and specificity of diagnosing were higher by ultrasonography and MRI as compared with CT. ② For the bile duct hamartoma and Caroli diease, they were manifested as multiple cysts, widely distributed in the whole liver, without enhancement for the most lesions. The multiple cystic lesions without communicating with the bile duct was the key sign of differential diagnosis for these two dieases. ③ Enhancing mural nodules were more common in cystadenocarcinoma than cystadenoma. The accurate diagnosis of biliary cystadenoma depended on combination of ultrasonography, CT, and MRI findings. ④ For the cystic liver metastatic tumor, it was multiple cystic neoplasms in the liver parenchyma or around the liver. CT was the main method for the diagnosis, and which showed that the density was lower than that of the liver parenchyma, peripheral ring-enhanced lesion as enhanced scan. It was easy to distinguish with simple hepatic cyst by MRI. ⑤ For the cystic hepatocellular carcinoma, it presented as a multilocular cystic solid tumor. The presence of tumor thrombus in portal vein could help to the diagnosis. ⑥ For the undifferentiated embryonal sarcoma, CT plain scan showed the cystic low density mass with clear boundary, the edge with calcification, enhanced scan showed that the soft tissue composition presented continuous strengthening sign. There was no specific signal in MRI plain scan, and the periphery of the tumor was slowly strengthening. ⑦ For the liver abscess, it was easy to diagnose because it had different characteristic features in different pathological phase, but it was misdiagnosis of intrahepatic cholangiocarcinoma when its symptoms were atypical. ⑧ The ultrasonography and the CT were the optimal methods for the hepatic cystic echinococcosis and the hepatic alveolar echinococcosis respectively. The significances of imaging were to determine the activity of hydatid cyst and to identify anatomy structure among alveolar echinococcosis, bile duct and blood vessel, and judge invasion or not, MRCP was important for diagnosis. Conclusions Abdominal ultrasonography could be used as the first choice for diagnosis of cystic liver lesions, CT and MRI could be used as effective supplementary methods for it. A combination of various imaging techniques is key to diagnosis. Moreover, number and morphology of lesion, and solid component or not are important imaging features of diagnosis and differential diagnosis of cystic liver lesion.
ObjectiveTo explore the safety and feasibility of contrast enhanced intraoperative ultrasonographyguided percutaneous radiofrequency ablation with artificial hydrothorax to hepatocellular carcinoma in the hepatic dome. MethodsThe clinical data of nine patients with hepatocellular carcinoma in the hepatic dome underwent ultrasonographyguided percutaneous radiofrequnecy ablation with artificial hydrothorax from January 2008 to June 2009 at Department of Hepatobiliopancreatic Surgery of West China Hospital were retrospectively analyzed. The perioperative results and recurrence of tumor were also analyzed. ResultsAll of nine patients with twelve tumors received successfully radiofrequency ablation with artificial hydrothorax of (2 444±464) ml (2 000-3 000 ml). The ablation time was 12-24 min (median 12 min), with an average of (15±5) min for each tumor. No hemothorax, pneumothorax, and death occurred during operation. One patient had ascites of 2 000 ml after ablation due to hypoalbuminenia, and ascites disappeared by infusion of abumin on 4 d after operation. The total volume of pleural drainage was 250-1 420 ml, with an average of (717±372) ml for each patient, and the drainage tube was withdrawn on 3-5 d after operation. The followup time was 7-23 months (mean 15 months). Tumor recurrence was found in three patients on 5, 6, and 7 months after operation, respectively. Of them, two patients were in stable disease stage after interventional and conservative therapy, respectively, and one case recurred at six months after operation and died of hypertensive heart disease and hepatic function deterioration at sixteen months after operation. The rest patients survived and no recurrence and metastasis was observed during the follow-up period.ConclusionThe technique of percutaneous radiofrequency ablation with artificial hydrothorax increases the feasibility of the minimal invasive treatment for hepatoma, which can be applied to hepatocellular carcinoma in the hepatic dome with high safety and clinical application value.
ObjectiveTo investigate the value of contrastenhanced ultrasonography in differential diagnosis between benign and malignant breast mass. MethodsTotally 65 patients with 70 breast masses were evaluated by general ultrasonography and contrastenhanced ultrasonography with contrast agent SonoVue. The related indexes, such as the degree and mode of contrast enhancement, the lesion boundaries and dissipation mode, were used to describe the difference between benign and malignant mass, which was also compared with pathological results. ResultsHistopathological examination revealed that benign mass was in 37 cases and malignant in 28 cases. The sensitivity, accuracy, positive predictive value, and negative predictive value of contrastenhanced ultrasonography with contrast agent SonoVue were significantly higher than that of general ultrasonography (Plt;0.05), while no significant difference in diagnostic specificity and misdiagnosis rate was observed between them (Pgt;0.05). All tumors showed contrast enhancement in various degrees. Of 28 patients with enhanced mass, hyperenhancement in 22 cases and nodular inhomogeneous enhancement in 21 cases were observed and the boundaries of malignant tumor were irregular with ill-defined and radial enhancement. Most of benign tumors were represented by weak, homogeneous enhancement, and the shape was regular with smooth and tidy boundary and intact capsule except seven cases with unclear boundary. These imaging characteristics of benign and malignant tumors were obviously different (P=0.000). In the resolution phase, both benign and malignant mass showed heterogeneous or homogeneous dissipation, which was not significantly different (P=0.791). ConclusionCompared with general ultrasonography, contrast enhanced ultrasonography may be more helpful for the differential diagnosis of benign and malignant breast tumors.