Objective To investigate the quantitative analysis of tissue diffusion of real-time elastography(RTE) in chronic renal allograft injury(CRAI) and the relationship between RTE and the level of serum creatinine(Cr).Methods Sixty-nine cases of allograft renal transplantation patients were detected by conventional ultrasound and RTE.According to the time after operation and Cr,they were divided into three groups:group A (in three months after operation and normal Cr,25 cases),group B (more than three months after operation and normal Cr,23 cases),and group C (more than three months after operation and high Cr,21 cases).The results were compared and analyzed.Results ①Contrast between group A and group B,there were differences on Cr and average ralative strain value(MEAN),area ratio of low-strain region (％ AREA),complexity (COMP),skewness (SKEW),(P ＜ 0.05).② In group B,there was correlation between Cr and ％AREA,MEAN,SKEW (r =0.682,P ＜0.05; r =0.628,P ＜0.05; r =-0.481,P ＜0.05).③To make ROC curve,MEAN has higher sensitivity (90.9％),COMP has higher specificity and accuracy (68.0％,81.8％).④ To apply the third result in group C,4 or 5 cases in 21 were abnormal.Conclusions There is a good correlation between the quantitative analysis of tissue diffusion and the level of serum creatinine.RTE can indirectly reflect CRAI,and it is a new method of ultrasonic to evaluate renal allograft function.

Objective To investigate the clinical value of contrast-enhanced ultrasound (CEUS) in the diagnosis of postoperative complications after pancreas transplantation.Methods Eighty-six post pancreastransplantation patients were examined by CEUS to observe the perfusion of contrast agent,plot timeintensity curve (TIC),and compare to the results of enhanced CT,MRI and pathology.Results Eleven cases of thrombosis,13 cases of rejection and 13 cases of pancreatitis were observed among 86 patients.Result from CEUS showed that:① Distribution of normal pancreatic grafts vascular and parenchyma was even,TIC follows positive skewed distribution.②Thrombosis:there was no perfusion in the embolic vessels and no enhancement or low uneven enhancement in the parenchyma.③ Rejection:perfusion of the parenchyma was slow,peak value was decreased,rising and falling slope of the TIC was reduced with blunt peak.④Pancreatitis:perfusion of the parenchyma was uneven,the regional low enhanced area was visible,clear of the contrast agent was relatively slow,rising slope of TIC was reduced and the peak value was decreased.Conclusions CEUS can monitor the perfusion of the pancreatic grafts vascular and parenchyma,and get useful perfusion parameters.It has been proven as an effective method to definitely diagnose postoperative complications after pancreas transplantation.

Objective To investigate the clinical value of contrast-enhanced ultrasound (CEUS) in the diagnosis and grading of acute rejection of the transplanted pancreas after simultaneous pancreas-kidney transplantation.Methods Seventy cases pancreas grafts underwent gray scale ultrasound,color Doppler flow imaging(CDFI) and CEUS examination,the contrast agent perfusion processes were observed,and the parameters of time intensity curves(time-intensity curve,TIC) were calculated.The CEUS results were compared with the pathological findings.Results Twenty-one cases were acute rejection in 70 cases,of which 10 cases were mild,8 cases were moderate and 3 cases were severe;and 49 cases were non-rejection.①Gray scale and CDFI ultrasound:The pancreatic grafts of acute rejection were edema and enlarged,the parenchyma echo were decreased.The artery resistance index(RI) were significant different between acute rejection group and non-rejection group (0.77 ± 0.05 vs 0.74 ± 0.10,P ＜0.05),but there were no significant differences between mild,moderate and severe group (P ＞0.05).②CEUS:TIC curves showed a significantly longer time to reach peak [TTP,(21.7 ± 4.3)s vs (13.0 ± 2.9) s,P ＜0.01] and significantly reduced peakintensity(PI,18.8 ± 7.9 vs 29.6 ± 2.4,P ＜0.05).There was no significant difference between the mild and moderate groups (P ＞0.05) but statistically difference was found when the severe group compared with the other two groups (P ＜0.05).Conclusions CEUS can be used to observe the perfusion of the vascular and parenchyma of the pancreas,the results also can be quantitative analyzed.It is an effective method for the diagnosis of pancreas acute rejection of simultaneous pancreas-kidney transplantation.

Objective To investigate the value of ultrasound multiplex mode in the evaluation ot liver damage caused by brain death.Methods Brain death model were established in 12 Ba-Ma pigs by gradual intracranial compression method.Color Doppler flow imaging (CDFI),contrast-enhanced ultrasonography (CEUS) and real-time elastography (RTE) were performed respectively before the model had been established which defined as control group,and at 0 h,3 h,6 h,9 h after brain death,the data were analyzed.According to the pathological changes of liver,the livers were divided into different groups for ROC curve analysis,and the effectiveness of single mode ultrasound and multiplex were compared.Results ①Compared with control group,velocity of portal vein (PVV) decreased,and resistance index(RI),hepatic artery systolic velocity/diastolic velocity (S/D),pulsatility index (PI) increased in experimental group (all P ＜ 0.05);arrival time of the hepatic artery(ATHA),arrival time of the portal vein(ATPV) and arrival time of the inferior vena cava(ATIVC) increased with the extension of brain death time (all P ＜0.05);mean value (MEAN),standard deviation(SD) of the relative strain value within the ROI,area of low strain within the ROI (％ AREA),complexity of low strain area within the ROI (COMP),skewness (SKEW),correlation(CORR) were significant different between experimental group and control group (all P ＜0.05).②RI,ATHA and MEAN demonstrated the highest diagnostic accuracy (AUC =0.518,0.833,0.917) among CDFI,CEUS and RTE indexes.③Combined with ATHA and MEAN had the highest effectiveness in ultrasound multiplex mode to evaluate liver injury caused by brain death.Conclusions Ultrasound multiplex mode combining CEUS and RTE in evaluation of liver injury caused by brain death has higher sensitivity and accuracy.

Objective:To explore the diagnostic efficacy of ultrasonography and follow-up outcomes of hepatic venous outflow obstruction after liver transplantation(LT)in children.Methods:From July 2017 to January 2022, 32 children diagnosed with outflow tract obstruction post-LT are designated as HVOO group and examined by digital subtraction angiography(DSA).All of them underwent balloon dilation.Thirty cases with no vascular complications are selected as control group.Color Doppler blood flow parameters are recorded, including peak systolic velocity(PSV), peak diastolic velocity(PDV), PSV/PDV(S/D), resistive index(RI), portal vein velocity(PVV), hepatic vein velocity(HVV), hepatic vein waveform, anastomotic velocity and waveform.Intravascular pressure values of DSA within 48h are recorded.The correlations between color Doppler flow parameters and intravascular pressure values are examined before and after tube expansion.The differences of color Doppler flow parameters before tube expansion between HVOO and control groups are compared.And receiver operating characteristic(ROC)curves are plotted for obtaining ultrasonic parameters' cut-off value.Patients with excellent recovery are selected for comparing the difference of color Doppler blood flow parameters before and after tube expansion and detect the trend of hemodynamics.Results:There is a positive correlation between anastomotic velocity of hepatic vein and inferior vena cava and DSA before and after tube expansion in HVOO group(r=0.483, 0.414, all P<0.05); S/D, RI and anastomotic velocity are higher in HVOO group than those in control group( Z=-3.275, P=0.001; t=3.437, P=0.001; Z=-5.677, P<0.01); PV and HVV are lower in HVOO group than those in control group( Z=-2.719, P=0.007; Z=-6.762, P<0.01); The waveforms of hepatic vein and anastomosis in HVOO group are mostly single-phase waves, accounting for 81.25%(26/32)and 53.12%(17/32).Control group is mostly of dual-phase wave.According to ROC curve analysis, area under curve(AUC)of HVV diagnosing HVOO is 0.996 with a critical value of 21.65 cm/s; AUC of hepatic vein anastomosis velocity is 0.92 with a critical value 162 cm/s and AUC of RI 0.76 with a critical value of 0.73.PVV and HVV values after tube expansion are higher than before tube expansion( Z=-2.233, P=0.026; Z=-4.45, P<0.01); Anastomotic velocity after tube expansion is lower than that before tube expansion( t=8.584, P<0.01).The waveforms of hepatic vein and anastomosis are mostly of single-phase waves(76.92%, 61.54%)before tube expansion and dual-phase wave(88.46%, 96.15%)after tube expansion. Conclusions:Color Doppler ultrasound is a preferred imaging modality for diagnosing HVOO and conducting postoperative follow-ups in children after LT because of its non-invasiveness, real-time, simplicity and rapidness.Furthermore, the diagnostic efficiencies of hepatic vein and anastomotic velocity are relatively high.

Objective:To investigate the value of ultrasound elastography combined with serum urokinase plasminogen activator (uPA) in differential diagnosis of benign and malignant thyroid nodules.Methods:From May 2018 to May 2019, 150 patients with thyroid nodules (160 nodules) were selected, 69 patients with benign nodules (76 benign nodules) and 81 patients with malignant nodules (84 malignant nodules) were diagnosed by postoperative pathology. In the same period, 40 healthy people underwent health examination were selected as the control group. All preoperative patients were subjected to ultrasound elastography. The results of pathological examination were diagnosed as "gold standard"; the characteristics of ultrasound elastography were observed and scored, and compared with the results of pathological examination. The level of serum uPA was measured by enzyme-linked immunosorbent assay (ELISA), the sensitivity, specificity, and the area under the receiver operating characteristic (ROC) curve (AUC) were compared among single real-time ultrasound elastography, serum uPA and combined diagnosis.Results:Among the 150 patients (160 nodules), for ultrasound elastography, the sensitivity was 97.37% (74/76), the specificity was 85.71% (72/84), the accuracy was 91.25% (146/160), and the Kappa value was 0.726. The ratio of 0 to 2 points in malignant group was significantly lower than that in the benign group, the ratio of 3 to 4 points was significantly higher than that in the benign group ( P < 0.05). Compared with the control group, the levels of serum uPA in the benign group and the malignant group increased significantly ( P < 0.05). Compared with the benign group, serum uPA level in the malignant group increased significantly ( P < 0.05). The AUC of combined diagnosis was 0.869, 95% confidence interval ( CI): 0.789 - 0.949, and the best cut-off point for the combined diagnosis was uPA = 982.16 mU/L, at this time, the diagnostic sensitivity was 0.646, and the diagnostic specificity was 0.575. The AUC of ultrasound elastography was 0.814, 95% CI: 0.721 - 0.907, and the AUC of combined diagnosis was higher than that of ultrasound elastography. Conclusion:The clinical value of ultrasound elastography combined with serum uPA in differentiating benign and malignant thyroid nodules is higher than that of ultrasound elastography.

Objective:To analyze the diagnosis of renal injury caused by chronic arsenism by color Doppler ultrasound and the observation of renal hemodynamics.Methods:From January 2018 to April 2019, 74 patients with occupational chronic arsenism admitted to Binzhou People's Hospital were selected and divided into two groups according to whether the patients were complicated with renal injury or not, 26 patients in renal injury group and 48 patients in non-renal injury group. The renal function indexes [serum creatinine (SCr), blood urea nitrogen (BUN), urine and blood β2-microglobulin (β2-MG)] were measured and the renal hemodynamics [peak blood flow velocity during systole (Vmax), minimum blood flow velocity during diastole (Vmin), resistance index (RI)] of the two groups were analyzed by color Doppler ultrasound, and the correlation between renal function indexes and renal hemodynamics was analyzed.Results:The levels of SCr, BUN, urine β2-MG and blood β2-MG in renal injury group were significantly higher than those in non-renal injury group [(136.28 ± 21.05) vs (108.42 ± 26.49) μmol/L, (8.03 ± 1.04) vs (5.36 ± 0.97) mmol/L, (157.48 ± 25.63) vs (127.42 ± 18.95) μg/L, (3.97 ± 1.12) vs (2.35 ± 0.84) mg/L, t = 4.625, 11.022, 5.740, 7.028, P < 0.05]. The Vmax and Vmin of the main renal artery and interlobular artery in renal injury group were significantly lower than those in non-renal injury group [cm/s: (50.34 ± 13.42) vs (75.32 ± 16.52), (18.13 ± 5.21) vs (29.83 ± 7.05), (12.31 ± 3.82) vs (17.22 ± 5.07), (4.08 ± 1.15) vs (6.03 ± 1.93), t = 6.833, 7.084, 4.657, 4.775, P < 0.05], and the RI of the main renal artery and interlobular artery in renal injury group was significantly higher than that in non-renal injury group [(0.71 ± 0.06) vs (0.62 ± 0.08), (0.68 ± 0.10) vs (0.56 ± 0.08), t = 5.017, 5.634, P <0.05]. Vmax and Vmin of the main renal artery and interlobular artery were negatively correlated with SCr, BUN, urine β2-MG and blood β2-MG ( P < 0.05). RI of the main renal artery and interlobular artery were positively correlated with SCr, BUN, urine β2-MG and blood β2-MG ( P < 0.05). Conclusions:Color Doppler ultrasound can effectively reflect the status of renal injury in chronic arsenism patients. The renal blood flow perfusion in renal injury patients is decreased, and the blood flow resistance is increased, which is closely related to the degree of renal injury and deserves clinical attention.

Objective:To obtain the normal reference range of ultrasound hemodynamic parameters after liver transplantation through big data query and statistical analysis, and to analyze its influencing factors.Methods:The clinical liver transplantation Ultrasound Image Database Software V1.0 developed by Tianjin First Center Hospital was used to query adult patients after liver transplantation from December 2012 to June 2021. The ultrasonic hemodynamic parameters including the diameter of portal vein (PVD), the flow velocity of portal vein (PVV), the peak flow velocity of hepatic artery (S), the end diastolic flow velocity of hepatic artery (D), the S/D of hepatic artery, the resistance index of hepatic artery (RI), the diameter of middle hepatic vein (MHVD), the flow velocity of middle hepatic vein (MHVV), the diameter of right hepatic vein (RHVD), the flow velocity of right hepatic vein (RHVV), in the first day (1D), the seventh day (7D), the first month (1M), the sixth month (6M), the first year (1Y), the fifth year (5Y) and the tenth year (10Y) after operation were analyzed statistically, and the 95% reference value range of each parameter was obtained.Results:A total of 1 740 patients with 12 242 monitoring results after adult liver transplantation were included, and the longest follow-up time was 22 years. There was no significant change in PVD. PVV decreased slightly from postoperative 1D to long-term follow-up. The S and D of hepatic artery were the highest in group 7D after liver transplantation, and then decreased gradually with the extension of postoperative time. Hepatic artery S/D was the lowest in group 7D after operation, with the extension of monitoring time after liver transplantation, it showed an upward trend, but fluctuated. Hepatic artery RI was the highest in postoperative 1D group, and fluctuated with the extension of monitoring time after liver transplantation. There was no significant change in MHVD and RHVD.MHVV and RHVV were the highest in group 7D after liver transplantation, with the extension of postoperative monitoring time, they showed a decreasing trend and fluctuated. The normal range of each parameter was estimated according to the range of 95% medical reference value. The influencing factors of blood flow monitoring of transplanted liver were analyzed, including the various factors in perioperative period, the surgery, the primary disease before operation, the source of donor, the postoperative infection, rejection, drug damage, individual differences and so on.Conclusions:This study obtains the trend of each parameter with the extension of follow-up time and the reference value range of each parameter after liver transplantation, which is of great clinical significance for early detection and diagnosis of postoperative vascular complications. However, the blood flow after adult liver transplantation is affected by many factors. In clinical monitoring, it is necessary to make judgment combined with the individual state of patients and conduct dynamic follow-up.

Objective To assess the value of passive leg raising (PLR) combined with echocardiography in predicting volume responsiveness in patients with septic shock. Methods Thirty septic shock patients with spontaneous respiration admitted to intensive care unit (ICU) of Tianjin First Center Hospital from July 2016 to August 2018 were enrolled. PLR and volume expansion (VE) were performed successively. The hemodynamic parameters including left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), stroke volume (SV) and left ventricular ejection fraction (LVEF) before PLR (baseline level), after PLR, immediately after VE were examined by echocardiography, and the central venous pressure (CVP) was monitored. The patients with increase in SV after VE (ΔSV) ≥ 15% were served as reaction group, while ΔSV < 15% were served as non-reaction group. The changes in LVEDV, LVESV, SV, LVEF and CVP at baseline level, after PLR and after VE were compared between the two groups. Pearson correlation method was used to analyze the correlation between ΔSV, increase in LVEF (ΔLVEF) after PLR and ΔSV, and ΔLVEF after VE. Receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of ΔSV and ΔLVEF after PLR for volume responsiveness. Results PLR and VE were successfully performed in 30 patients, of which 23 patients (76.7%) were enrolled in the reaction group, and 7 patients (23.3%) in the non-reaction group. Compared with baseline levels, LVEDV, SV, and LVEF in the reaction group were significantly increased after PLR [LVEDV (mL): 83.5±9.6 vs. 77.1±6.2, SV (mL): 48.5±5.6 vs. 43.2±4.9, LVEF: 0.58±0.04 vs. 0.56±0.06, all P < 0.05], and CVP was significantly increased after VE [cmH2O (1 cmH2O = 0.098 kPa): 7.4±3.3 vs. 4.6±0.7, P < 0.01], however, there was no significant change in LVESV. In the non-reaction group, SV and LVEF were significantly increased after PLR as compared with those at baseline levels [SV (mL): 42.7±3.7 vs. 40.6±3.1, LVEF: 0.52±0.05 vs. 0.50±0.05, both P < 0.05], while LVEDV and CVP were significantly increased after VE as compared with those at baseline levels [LVEDV (mL): 84.4±4.1 vs. 80.6±5.9, CVP (cmH2O): 10.6±3.5 vs. 7.6±0.5, both P < 0.05], however, there was no significant change in LVESV. Pearson correlation analysis showed that ΔSV and ΔLVEF after PLR were positively correlated with ΔSV and ΔLVEF after VE (r1 = 0.86, r2 = 0.65, both P < 0.01). ROC curve analysis showed that the area under ROC curve (AUC) of PLR-induced ΔSV and ΔLVEF for predicting volume responsiveness was 0.85 and 0.66 respectively. When the cut-off value of ΔSV after PLR was 10.6%, the sensitivity was 78.2%, the specificity was 82.3%; when the cut-off value of ΔLVEF after PLR was 3.6%, the sensitivity was 78.2%, and the specificity was 73.2%. Conclusion ΔSV and ΔLVEF measured by PLR combined with echocardiography can be used to evaluate the volume responsiveness in patients with septic shock and can guide fluid therapy.

Objective To investigate the application value of the tissue diffusion quantitative analysis technique of real-time elastic( RTE) imaging in evaluation of liver damage caused by brain death . Methods Fifty cases of brain dead donor liver were examined by ultrasound elastography ,at the same time , 11 parameters were obtained by the tissue dispersion quantitative analysis software ,included MEAN ( mean relative strain value within the ROI) ,SD( standard deviation of the relative strain value within the ROI) ,％AREA (area of low strain within the ROI) ,COMP(complexity of low strain area within the ROI) ,KURT (kurtosis) ,SKEW(skewness) ,CONT (contrast) ,ENT(entropy) ,IDM(inverse difference moment) ,ASM (angular second moment) ,CORR(correlation) ,and the pathologic specimens in the process of operating were obtained . According to pathological findings ,50 patients were divided into damaged group and non-damaged group ,and the results were compared and analyzed . The correlation analysis of electronic speculum results and RTE were carried out . According to the ROC curve ,the RTE parameters'cut-off value and AUC were obtained .Results Among 11 parameters of tissue diffusion analysis ,MEAN and IDM in damaged group were higher than those in non-damaged group( all P < 0 .05) ;and SKEW and ENT were lower in damaged group than those in non-damaged group ( all P <0 .05) ;there was no significant difference in the other parameters between the two groups(all P >0 .05) . The MEAN ,SKEW ,COMP ,ENT and IDM had correlativity with electronic speculum( r = -0 .633 , P =0 .000 ;r =0 .388 , P =0 .005 ;r =0 .315 , P =0 .026 ;r = 0 .324 , P = 0 .022; r = -0 .314 , P = 0 .026 ,respectively ) . The diagnostic efficiency and sensitivity of MEAN were the highest , the critical value of MEAN was 125 .84 , AUC was 0 .907 . Conclusions The tissue dispersion quantitative analysis technique is a noninvasive method to preliminary evaluation of liver damage caused by brain death . M EAN had the highest effectiveness in eleven parameters .