Objective To study the ventricular-arterial coupling in the patients with type 2 diabetes mellitus (DM) by ultrasound.Methods Eighty patients with DM were divided into 2 groups:normal left ventricular ejection fraction (EF) group (DMN,EF≥50 ％,n =40) and abnormal EF group (DMA,EF＜50％,n =40).At the same time,42 healthy volunteers were selected as a control group.The left ventricular (LV) relative wall thickness (RWT),mass index (LVMI),stroke volume (SV),stroke works (SW),ratepressure product (RPP),systemic vascular resistance index (SVRI),LV end-systolic elastance (Ees),arterial elastance index (Ea) and ventricular vascular index (VVI) were measured and calculated.Longitudinal strain (LS) of myocardial segment including base(LSBA),papillary muscle (LSPM) and apex (LSAP) were analyzed by two-dimensional speckle tracking imaging.Results (1) Compared with the control,the RWT and LVMI were all increased (P ＜0.01),but the LSBA,LSPM and LSAP were decreased (P ＜ 0.01) in the DMN and DMA groups (P ＜0.01).In DMA group,the RWT,LSBA,LSPM and LSAP were decreased (P ＜0.01).Compared with the DMN group,the LSBA,LSPM and LSAP were decreased in DMN group (P ＜0.01).(2) Compared with the control,the Ea,VVI,RPP and SVRI were increased,but the Ees was decreased (P ＜0.05)in DMA group (P ＜0.01).In the DMN,RPP was increased compared with the control group (P ＜0.01).Compared with the DMN group,the Ea,VVI,RPP and SVRI were increased,but Ees was decreased in the DMA (P ＜0.05).(3)The LSBA,LSPM and LSAP were all positively correlated with VVI(P ＜0.01).Multiple regression analysis showed that the LSAP,RWT,LVMI and SW were independent predictor of VVI (b' =-0.613,-0.290,0.290 and-0.205,P ＜ 0.05).Conclusions The ventricular-arterial coupling is normal in the DMN group,but is abnormal in DNA group.LSAP is independent predictors for ventricular-arterial coupling.

Objective To assess the effects of captopril on renal perfusion of diabetic mellitus(DM)rabbits at early stage by contrast-enhanced ultrasound (CEUS).Methods Of 58 rabbits,6 were control group,37 were made as DM model successfully by alloxan and were randomly divided into 4 groups:untreatment group (n =16) and treatment group A,B and C (n =7 averagely).The treatment groups were given captopril(25 mg/kg weight) everyday by intragastric administration after the DM model established and renal pathology appeared Mogensen DN Ⅰ,Ⅱ or / and Ⅲ respectively.The treatment lasted 12 week.Then CEUS was performed on bilateral kidney to observe the renal perfusion,the parameters included:curve ascending slope(K1),time to peak intensity(PIT),peak signal intensity(PSI),area under the curve(AUC) and time to half of peak intensity(HPT).Results At the end of 12 weeks,compared with control group,PIT and HPT delayed,PSI and K1 decreased in untreatment group and group C,AUC of untreatment group increased.Compared with untreatment group,PIT,HPT and AUC decreased,PSI and K1 increased in group A,B and C.Compared with group C,HPT of treatment group A,B decreased.Compared with control group,renal's size increased and the cortex was thickened in untreatment group and group A,B,C.The pathological examination showed:renal were damaged more seriously in untreatment group than that in group A and B.There was no significant difference in Scr and BUN between all groups.Conclusions Assessment of CEUS for renal perfusion of diabetic mellitus rabbits at early stage is feasible and captopril can improve renal perfusion of DM rabbits.

Objective To assess the renal perfusion of different severity of hepatic cirrhosis by contrast-enhanced ultrasound with time-intensity curve.Methods Forty hepatic cirrhosis patients with normal conventional renal function enrolled the study and were subdivided into Child-Pugh A group ( n =14),Child-Pugh B group ( n =14) and Child-Pugh C group ( n =12).Thirty healthy subjects were selected as the control group.The parameters of perfusion were compared among the groups.The correlations between parameters and score of Child-Pugh were analyzed using Pearson correlation.Results The cirrhosis groups showed a decrease of peak intensity,increase of time to peak,and reduce of area under the curve in the renal cortex( P ＜0.05).Compared with Child-Pugh A group,the peak intensity decreased in both ChildPugh B and C groups,time to peak increased in Child-Pugh C group( P ＜0.05 or P ＜0.01 ).The peak intensity had negative correlation with Child-Pugh score( r =- 0.506,P ＜0.01 ).Conclusions Contrastenhanced ultrasound combined with time-intensity curve can assess renal perfusion of hepatic cirrhosis quantitatively.The peak intensity was correlated to the severity of cirrhosis.

Objective To probe into the characteristics of strain and strain rate in different time points of coronary artery disease (CAD) patients before and after the improvement of myocardial ischemia, to evaluate the value of two-dimensional strain (2DS) imaging in assessing curative effect of CAD patients. Methods The changes of strain and strain rate in local lesion segments before revascularization,and one week,one month and three months after revascularization of 24 CAD patients accepting revascularization therapy were detected by 2DS. Results Before revascularization treatment,the outlines of strain-time curves and strain-rate-time curves of lesion segments of CAD patients in whole cardiac circle were cluttered. The peak strain (S),the peak systolic strain rate (SRS) and the peak early diastolic strain rate (SRE) were low and calm. The peaks of strain-time curves in some segments of CAD patients were inverted. One week after treatment,the S, SRS,SRE and the peak late diastolic strain rate (SRA) of lesion segments of CAD cases elevated to certain extent. However, there were no statistical significant differences between them (P0.05). One month after treatment,the S and SRE of lesion segments of CAD patients elevated significantly compared to that of before the treatment (P<0.01). Three months after treatment,the outlines of strain-time curves and strain-rate-time curves of lesion segments of CAD patients trended to be regular,and the S, SRS, SRE and SRA elevated markedly compared to that of before treatment (P<0.01). There were statistical significant differences in terms of the S, SRS and SRA compared to that of one week and one month after treatment (P<0.01). Conclusions 2DS can evaluate the strain and strain rate non-invasively and quantitatively at different time points after revascularization of CAD patients. And it can evaluate regional myocardial systolic and diastolic function for CAD patients.

Objective To assess renal perfusion of chronic renal failure(CRF) at different stages in rabbits by contrast-enhanced ultrasound. Methods Fifteen rabbits were injected cationic bovine serum albumin(C-BSA) intravenously for 8 weeks to establish CRF models. Serum creatinine(Scr) and blood urea nitrogen(BUN) were determined before injection and 2,4,6,8 weeks after C-BSA injection respectively. The size of kidney was measured by two-dimensional ultrasound and contrast-enhanced ultrasound was performed on bilateral kidneys at the same time points. Renal perfusion was analyzed quantitatively with the time intensity curve. Results Renal cortical perfusion reduced started at 4weeks after injection,manifested as the peak signal intensity(PSI) of the time-intensity curve parameters decreased(P<0.05 or P <0.01). The speeds of perfusion and clearance of kidney were slower,showed as the time to peak intensity(PIT) and the time to half of peak intensity(HPT) delayed (P <0.05 or P <0.01). Compared with pre-injection, there were no differences in terms of the area under the curve(AUC) at 2,4 and 6 weeks after injection (all P> 0.05). And compared with pre-injection,2,4,6 weeks after injection, the AUC decreased at 8 weeks (P < 0.05 or P <0.01 ). The level of Scr and BUN of rabbits had increased since 6 weeks after injection (P< 0.05 or P <0.01). Two-dimensional ultrasound showed the renal volume was enlarged and the cortex was thickened from 2 weeks to 6 weeks after injection (P<0.05 or P <0.01). At 8 weeks after injection, the renal size had decreased as well (P < 0.05). These ultrasound changes were in accordance with its pathological changes. Conclusions Contrast-enhanced ultrasound in combination with time-intensity curve can quantitatively analyze the renal perfusion of CRF at different stages. The reduction of renal perfusion was earlier than the changes of routine laboratory indexes in rabbits with CRF. The haemodynamic changes of CRF rabbit were closely related with its pathological changes.

Objective To probe into the value of the evaluation of left ventricular myocardial function by two dimensional strain(2DS) for coronary artery disease(CAD) patients with different degrees of left anterior descending(LAD) branch stenosis. Methods Fifty-five eases without myocardial infarction among a total of 72 patients with CAD were divided in to 3 groups based on the extent of LAD stenosis,that was group A(stenosis<50%, n = 24) ,group B(stenosis50% to 75%, n = 19) ,and group C(stenosis>75%, n = 12). Another 17 eases of CAD with myocardial infarction were selected as group D. Strain and strain rate of the whole 11 segments that blood supplied by LAD of all cases were measured with 2DS. Results The 2DS ultrasound showed that the peak strain(S), the peak systolic strain rate(SRs) and the peak early diastolic strain rate (SRE) in all the 11 segments of group A were high and sharp. The above mentioned parameters of group B decreased compared with that of group A, however, there was no statistical significant difference (P >0.05). The S, SRs and SRE of group C cases decreased in some segments compared with that of group A and group B (P< 0.05 or P<0.01). As for group D, the S, SRS and SRE decreased significantly in all segments. In terms of the peak late diastolic strain rate (SRA), there were no statistical significant differences among group A,B and C (P>0.05). While in group D cases, the SRA decreased markedly. The SRE/SRA was more than 1 in group A. However, in group B, C and D cases, the SRE/SRA were all less than 1. Conclusions 2DS can sensitively reflect the decrease of regional myocardial systolic and diastolic function caused by the reduction of perfusion,and it may be beneficial to find myocardial ischemia for patients as early as possible.

Objective To investigate the function of the left ventricular (LV) myocardial regional contractility in hyperthyroid by measuring the LV rotation and torsion using speckle tracking imaging (STI).Methods 58 patients with hyperthyroidism had accepted 131 I treatment the first time and cured and improved after treatment for 6 months were enrolled.According to the course of disease,they were divided into two groups:Group A,duration less than 6 months,28 cases;Group B,duration more than 6 months,30 cases.30 normal cases age and gender matched were enrolled as control group.LV peak rotation and torsion of endocardium and epicardium at basal and apical of levels were measured using STI in groups A and B before and after treatment,and correlation with cardiac function and structure parameters,heart rate,blood pressure,and the thyroid hormone were analyzed.Results ①Comparing group A and group B before and after treatment with control group,there was no statistically significant in the LV structure and function parameters (LVDd,LVDs,IVSd,PWd,LVEF) (P ＞0.05).②As for LV peak rotation of endocardium and epicardium at apical levels (EN PAR,EP-PAR) before treatment,group A was higher than the control group (P ＜0.05),group B was lower than the control group (P ＜0.01);After treatment,group A has improved (P ＜0.01),group B has improved only in EP-PAR (P ＜0.05),and there was no statistically significant compared with the control group (P ＞0.05).③ LV peak torsion of endocardium and epicardium (EN-Ptor,EP-Ptor) in group A was higher than the control group before treatment (P ＜0.05),group B was lower than the control group (P ＜0.01) ;After treatment,group A has improved (P ＜0.05),group B has only improved in EP-Ptor(P ＜0.05),and comparing with the control group,there was no statistically significant (P ＞0.05).④LV peak apical rotation and LV torsion were positively correlated with systolic blood pressure,heart rate,E-peak,A-peak,LVOT-V in different degree (P ＜0.01 or P ＜0.05),but no correlation with FT3,FT4,TSH (P ＞0.05).Conclusions Myocardial contractile function strengthens in early patients with hyperthyroidism and lessens with the extension of the course.Have not yet appeared heart diseases in patients with hyperthyroidism whose myocardial regional systolic function had changed,short duration can recover after treatment,but the long duration can not restore completely.Change of myocardial motion of patients with hyperthyroidism is associated with blood flow dynamics.

Objective To explore the clinical value of high-frequency color Doppler ultrasound in the diagnosis of isolated calf muscle vein thrombosis (ICMVT). Methods Sonographic features of 175 patients with isolated calf muscular venous thrombosis were analyzed retrospectively and outcome of anticoagulant therapy in 1, 3, and 6 months was followed up. Diagnosis was established with high-frequency color Doppler ultrasound examination. Results One hundred and seventy-ifve patients presenting with 190 calf muscle vein thrombosis were included. One hundred and iffty-eight cases with 173 calf muscle vein thrombosis were diagnosed by high-frequency color Doppler ultrasound, 7 cases of misdiagnosis, missed diagnosis in 10 cases. The accuracy rate was 91.1%(173/190). Seven cases were misdiagnosed with 1 euroifbromatosis, 1 mixed hemangioma, 5 gastrocnemius hematoma. After diagnosis of ICMVT, all patients prescribed thrombolysis and anticoagulation therapy. High-frequency color Doppler ultrasound for 1, 3, 6 months after treatments revealed partial or complete recanalization without calf deep vein thrombosis. Typical sonographic features included:calf muscle venous lumen dilation, tortuous anechoic lumen or hypoechoic iflling, with tubular or branched shape in the longitudinal view and oval or round shape in the transversal view. Conclusion High-frequency color Doppler ultrasound is an accurate and reliable method in the diagnosis of the isolated calf muscular venous thrombosis.

Objective To investigate the value of color Doppler flow imaging(CDFI) in diagnosing lower limb artery in-stent restenosis (ISR), and to provide the evidences for clinical application. Methods Patients with lower limb artery percutaneous transluminal stent insertion in 12 months were enrolled in this study and divided into two groups, CT angiography (CTA) or digital subtraction angiography (DSA) was applied to diagnose ISR, 31 patients with 47 stenting which were diagnosed ISR was named as restenosis group, 63 patients with 89 stenting which were diagnosed no ISR was named as no stenosis group, and 30 normal person was enrolled and named as normal control group. Ultrasonic characteristics and peak systolic blood flow velocity (PSV), systolic blood flow acceleration time (AT) of proximal part, inner stents, distal part were recorded in restenosis group and no stenosis group, then compared with data in normal control group. Regression and receiver operator (ROC) curve were applied to analyse the correlation between PSV and AT. Results PSV of no stenosis group in common femoral artery, femoral artery, superifcial, popliteal artery stent respectively were (146.71±35.59) cm/s, (120.11±25.67) cm/s, (96.44±32.87) cm/s. PSV of normal control group in common femoral artery, femoral artery, superifcial, popliteal artery respective were (119.67±15.34) cm/s, (91.17±15.09) cm/s, (71.13±21.23) cm/s. There was statistically signiifcant difference between the two groups (t=2.457, 2.459, 2.321, all P<0.05). AT of no stenosis group in common femoral artery, femoral artery, superficial, popliteal artery stent respectively were (84.98±13.77) ms, (87.33±16.36) ms, (90.77±12.05) ms. AT of normal control group in common femoral artery, femoral artery, superficial, popliteal artery respective were (78.23±21.24) ms, (82.31±18.24) ms, (84.29±23.01) ms. There was no statistically signiifcant difference between the two groups (t=1.696, 1.904, 1.835, all P>0.05). PSV of restenosis group in proximal part, restenosis part, distal part respectively were (87.67±23.34) cm/s, (218.17±72.09) cm/s, (54.13±21.23) cm/s. PSV of no stenosis group in proximal part, inner stents, distal part respectively were (91.71±25.59) cm/s, (131.11±45.67) cm/s, (96.44±32.87) cm/s. There was statistically significant difference between restenosis part/inner stents, distal part (t=3.412, 3.511, both P<0.05). There was no statistically signiifcant difference between the two groups in proximal part (t=1.901, P>0.05). AT of restenosis group in proximal part, restenosis part, distal part respectively were (98.31±14.09) ms, (109.54±21.03) ms, (158.23±45.21) ms. AT of no stenosis group in proximal part, inner stents, distal part respectively were (84.98±13.77) ms, (86.34±19.36) ms, (83.77±17.05) ms. There was statistically signiifcant difference between restenosis part/inner stents, distal part (t=2.319, 3.610, both P<0.05). There was no statistically signiifcant difference between the two groups in proximal part (t=1.833, P>0.05). ROC curve showed that in ISR lower limb artery, PSV>168 cm/s had a sensitivity of 89.4%, speciifcity of 92.1%, the area under the ROC curve was 0.949;AT>127 ms, had a sensitivity of 86.8%, speciifcity of 98.0%, the area under the ROC curve was 0.867. Conclusions CDFI can detect the changes of PSV and AT, ISR can be detected and diagnosed earlier in lower limb artery. By combining PSV>168 cm/s with AT>127 ms, the value of ISR diagnosis can be increased.

Objective To evaluate the value of MicroPure imaging system of ultrasonography in display of breast calcification,and explore its clinical application value.Methods One hundred and forty-one patients underwent by mammography,conventional ultrasound imaging and MicroPure imaging,the mammography results were reference standard,observing the display rate of MicroPure imaging for calcification,and the value of MicroPure imaging in the display of calcification with different shapes on mammography.As the pathologic diagnosis was golden standard,the accuracy of diagnosis of conventional ultrasound,conventional ultrasound combined with MicroPure imaging,conventional ultrasound combined with mammography were evaluated with receiver operating characteristic(ROC) curve.Results The display case of calcifications within breast masses:the specificity of MieroPure imaging was lower than conventional ultrasound(88.14％ vs 100％,P ＜ 0.05),the sensitivity and accuracy were higher than conventional ultrasound(100％ vs 62.79％,93.14％ vs 84.31 ％,P ＜0.05).The display case of microcalcifications within normal breast tissue:the specificity and accuracy of MicroPure software system were lower than conventional ultrasound(9.26％ vs 100％,43.87％ vs 65.96％,P ＜0.05),the sensitivity was higher than conventional ultrasound (100％ vs 20.00％,P ＜0.05).The punctate calcification,amorphous calcification,rough uneven,pleomorphic calcifications on mammography were all hyperechoic spots on MicroPure software system.The area under the ROC curve of the conventional ultrasound,conventional ultrasound combined with MicroPure imaging,conventional ultrasound combined with MicroPure imaging was 0.881,0.858,0.932,respectively.Conclusions MicroPure imaging has some clinical value on microcalcifications within breast masses,which can improve its sensitivity and accuracy.The specificity of MicroPure imaging diagnostic ultrasound imaging of microcalcifications were lower,and it can not distinguish between different shapes of calcifications.Compared with conventional ultrasound,MicroPure imaging system can not improve the accuracy of diagnosis of benign and malignant breast lesions.