Objective To evaluate the clinical value of artificial hydrothorax combined with one-lung ventilation to aid ablation treatment of liver carcinoma in the hepatic dome.Methods Twenty-one patients with liver carcinoma located in the hepatic dome and affected by the lung gas were enrolled.Double lumen endobronchial intubation anesthesia was used and thoracical tube was used to apply artificial pleural effusion.The lesions'ultrasound image were recorded for the patients without artificial hydrothorax,or with artificial hydrothorax only and artificial hydrothorax combined with one-lung ventilation.Ultrasound images were reviewed and scored as 1-5 according to the clarity and completeness of the lesion.Ablation efficacy and adverse reactions were recorded in the follow-up.Results Twenty-one patients were successfully applied artificial hydrothorax and one lung ventilation.The average normal saline used for artificial hydrothorax were (738± 260)ml.The ultrasound score for not using artificial hydrothorax,using artificial hydrothorax only and artificial hydrothorax combined with one lung ventilation were 1.13 ± 0.35 (1-2),3.00 ± 0.85 (2-5) and 4.53 ± 0.64(3-5),respectively,statistical difference was found between each method(P ＜0.05).Artificial hydrothorax combined with one-lung ventilation had much higher ultrasound score than the other 2 methods.No complication related to artificial hydrothorax or one-lung ventilation was found.CT/MRI at one month after ablation showed that all the lesions were completely ablated.In the follow-up for 2-14 months on average,1 case of local tumor progression and 1 case of intrahapetic relapse were found.Conclusions Artificial hydrothorax combine one-lung ventilation could effectively enhance ultrasound image for the lesions in the dome whose acoustic window was affected by lung gas.

Objective To compare the value of two‐dimensional shear wave elastography (2D‐SWE) and real‐time tissue elastography (RTE) in the assessment of liver fibrosis in patients with chronic liver disease. Methods One hundred and ten patients with chronic liver disease scheduled for liver biopsy were studied. Both 2D‐SWE and RTE were performed on these patients in a same day. The correlation coefficient of liver fibrosis level, receiver operating characteristic (ROC) curve of S≥2, and S=4 of 2D‐SWE and RTE were compared according to pathologic results. Results The correlation coefficient of liver fibrosis level for 2D‐SWE ( r =0 7.76, 95% CI 0 6.83 -0 8.45, P =0.000) was higher than that of RTE ( r =0 5.61, 95% CI 0 4.07-0 6.84, P =0.000)( Z =2 9.3, P =0.003). The area under ROC curve for S≥2 and S=4 of 2D‐SWE were 0 8.66 and 0 9.57 respectively, RTE were 0 7.50 and 0 8.43 respectively, which indicated that 2D‐SWE was better than RTE. Conclusions The diagnostic performance of 2D‐SWE was better than RTE for the assessment of liver fibrosis and cirrhosis.

Objective To obtain the elasticity value of benign and malignant breast solid lesion with real-time shear wave elastography (SWE),in order to assess the value of quantitative elastography with SWE in diagnosis of benign and malignant breast solid lesions.Methods From June 2012 to November 2012,SWE was performed in 125 breast lesions of 103 female patients with pathologically confirmed results,to obtain the elastic modulus (mean,maximum,minimum).Taking pathologic results as reference,ROC curves were used to assess diagnostic performance.Results 87 lesions of 66 patients were pathologically confirmed benign whereas 38 lesions of 37 patients were malignant.The maximum,mean,and minimum elasticity value of benign lesions was 47.2 (7.4-192.0) kPa,22.4 (1.8-90.7) kPa,36.3 (5.3-124.7)kPa; whereas of malignant ones was 192.0(42.7-300.0)kPa,68.1 (0.1-192.0)kPa,138.0(23.9-271.1)kPa.The maximum,minimum and mean elasticity value between benign and malignant lesions had statistically significant difference(P ＜0.01).The area under the ROC curve of the maximum,minimum and mean elasticity value was 0.935,0.853 and 0.917(P ＜0.01).Taking 87.65 kPa as the threshold of the maximum elasticity value,the sensitivity was 91.4％ and the specificity was 88.5％.Taking 37.15 kPa as the threshold of the minimum elasticity value,the sensitivity was 80.0％ and the specificity was 83.9％.Taking 66.85 kPa as the threshold of the mean elasticity value,the sensitivity was 85.7％ and the specificity was 88.5％.Conclusions SWE can assess the stiffness of the breast solid neoplasm by quantitatively measuring the elastic modulus,thus providing diagnostic basis in differential diagnosis of breast lesions.SWE elastic modulus value measurement for breast solid lesions provides a new effective and objective diagnostic method.

Objective To explore the feasibility of detecting liver stiffness by real-time shear wave elastography (SWE) and establish a reference range of shear modulus in healthy liver of adults.Methods 335 adults underwent SWE detection to obtain the shear modulus of livers.The effects of different gender and age on the shear modulus in normal adult were analyzed.Thirty subjects were performed by two operators respectively to evaluate interobserver agreement.Results 329 health volunteers were detected successfully.The success rate was 98.2 ％.The mean value of SWE measurements in normal individuals was (5.023 ± 0.966)kPa.The liver shear modulus of healthy adults had a 95％ confidence interval from 4.918-5.128 kPa.There were no significant differences between the mean SWE values in men vs women (P =0.218),also among different age groups (P =0.271).No statistically significant was observed between the mean SWE values obtained by two different operators (P =0.498),interobserver ICC value was 0925.Conclusions SWE is a repeatability and stability method to access liver stiffness on healthy subjects.In our study the mean liver stiffness value obtained by SWE in healthy subjects was 5.023 kPa.The mean liver stiffness value obtained by SWE did not influenced by sex and age.

Objective To assess the safety and effectiveness of artificial ascites assisted thermal ablation for hepatic tumors adjacent to the gastrointestinal tract in patients with a history of abdominal surgery . Methods Thirty‐two patients (33 lesions located adjacent to the gastrointestinal tract) with a history of abdominal surgery were included in the study . Method ① :normal saline was injected into abdominal cavity to form water insulation band between liver and gastrointestinal tract . Method② :normal saline was injected with appropriate pressure to form local water insulation band between the liver and gastrointestinal tract . Method③ :normal saline was injected continuously at the interval between liver and gastrointestinal tract to flush away heat energy caused by ablation . All the patients were checked for gastrointestinal tract injury after ablation . During one month after ablation ,CT /MR was performed to evaluate whether the lesions were completely ablated . Results Respectively ,the numbers of lesion received method ① ,② and ③ were 27(81 .8% ) ,4(12 .1% ) and 2(6 .1% ) ,while the usage of normal saline were 400~2 000 ml ,600~800 ml and 1 000~1 500 ml . No gastrointestinal tract injury occurred . CT/MR scan during one month after ablation showed that all the 33 lesions had been completely ablated . Conclusions In patients with a history of abdominal surgery ,artificial ascites is a safe and effective method in assistance of thermal ablation for hepatic tumors adjacent to the gastrointestinal tract .

Objective To evaluate the feasibility and efficacy of mono-modality fusion imaging using ultrasound in the intraoperative immediate evaluation of therapeutic response of liver cancer thermal ablation.Methods A total of 70 liver cancers in 53 patients that underwent thermal ablation from October to November 2015 were included in this study.Mono-modality fusion imaging using ultrasound was applied immediately after the ablation procedure to evaluate the therapeutic response of the thermal ablation.The applicable rate,the success rate of registration,the duration time,the evaluation results and the rate of supplemental ablation were recorded.Ultrasound examination was performed on the first day after ablation to evaluate the early complication.Contrast-enhanced CT/MR within 1-3 months after the procedure was regarded as the golden criteria of the treatment response.In the follow-up period,the rate of local tumor recurrence,progression-free survival and overall survival were analyzed.Results The applicable rate for mono-modality ultrasound fusion imaging is 62.9％ (44/70) while the success rate of registration is 90.9％ (40/44).The duration time for mono-modality is 2.7-7.5 min,with an average of (3.9 ± 0.9) min.Thirty-seven out of 40 liver cancers were evaluated to achieve safety margin and 3 out of 40 were not.The rate of supplemental ablation was 40％ (16/40).The rate of complete ablation was 97.3％ (36/37) according to contrast-enhanced CT/MR within 1-3 months.In the follow-up period,no local tumor recurrence was observed and the rates of intra-hepatic recurrence and overall survival were 46.7％ (14/30) and 96.7％ (29/30),respectively.Conclusions Mono-modality ultrasound fusion imaging is a convenient,feasible,safe and efficient method in the intraoperative immediate evaluation of therapeutic response of liver cancer thermal ablation.

[Objective]To compare the clinical application value of fusion imaging of ultrasound(US)and computed tomogra-phy(CT)or magnetic resonance(MR)(US-CT/MR fusion imaging)and fusion imaging of US and three-dimensional US(US-US fusion imaging)in treatment response assessment of thermal ablation combined with other surgeries and procedures.[Methods]This clinical research included patients confirmed with liver cancers that underwent thermal ablation combined with other surgeries and procedures from Aug to Dec 2015. Both US-CT/MR and US-US fusion imaging together with contrast-enhanced US was applied on the same patient to assess the treatment response of the thermal ablation during the ablation procedure. The applicable rate ,the success rate of registration and the duration required for fusion imaging were recorded and compared. Contrast-enhanced CT/MR 1-3 months after the ablation procedure was taken as the golden reference of the technical efficacy rate for ablation.[Results]67 liver can-cers in 50 patients were enrolled in this clinical research in total. The ablation of 47 lesions in 37 patients were combined with artifi-cial hydrothorax or ascites ,14 lesions in 10 patients with open surgeries and 8 lesions in 5 patients with laparoscopy surgeries. The applicable rate for US-US fusion imaging[52.5%(35/67)]was lower than that for US-CT/MR fusion imaging[98.7%(66/67)](P<0.001)while the success rate of registration for US-US fusion imaging[88.6%(31/35)]was higher than that for US-CT/MR[66.7%(44/66)](P=0.018). The duration time for US-US fusion imaging[3.8 min(2.7~10.0 min)]was significantly shorter than that for US-CT/MR fusion imaging[5.5 min(3.0 ~ 14.0 min)](P < 0.001). No major complication related to ablation was observed. The technical efficacy rate for ablation was 100%(62/62)according to the contrast-enhanced CT/MR 1-3 months after the ablation proce-dure.[Conclusion]For ablation combined with other surgeries and procedures ,US-US fusion imaging should be priority when the tumor is conspicuous in US,especially for cases combined with open surgeries while US-CT/MR fusion imaging should be selected in some cases when the tumor is inconspicuous on US.

Objective To investigate the risk factors of hemorrhage after ultrasound-guided liver graft biopsy.Methods Clinical data of 51 liver transplant patients undergoing ultrasound-guided liver graft biopsy in the Third Affiliated Hospital,Sun Yat-sen University between February 201 3 and April 201 4 were retrospectively studied.Hemorrhage after biopsy was taken the dependent variable.Age,gender,coagulation, duration of biopsy,frequency of biopsy,number of biopsy tissues,medication of anticoagulant or not and cooperation in breathing and breath holding or not were taken as the independent variables.Multivariate non-conditional Logistic regression analysis was performed for all independent variables to screen out the risk factors associated with hemorrhage after ultrasound-guided liver graft biopsy.Results Fifty-one patients underwent 84 biopsies in total and 5 cases (6%)had hemorrhage after biopsy.The multivariate non-conditional Logistic regression analysis showed that obvious hemorrhagic tendency,medication of anticoagulant and poor cooperation in breathing were independent risk factors of hemorrhage after liver graft biopsy (OR was respectively 8.71 , 3.1 6 and 2.03,all in P <0.05).Conclusions Obvious hemorrhagic tendency,medication of anticoagulant and poor cooperation in breathing are independent risk factors of hemorrhage after ultrasound-guided liver graft biopsy.

Objective:To investigate the effectiveness and safety of the coaxial needle technique in percutaneous liver biopsy for patients with coagulation function abnormalities.Methods:Clinical data of 210 patients who underwent percutaneous liver biopsy using the coaxial needle technique under ultrasound guidance from December 2018 to May 2021 in 3 centers were collected. A retrospective analysis was conducted to compare the puncture success rate, number of samples obtained, pathology qualification rate, intraoperative and postoperative bleeding rates between the group with coagulation function abnormalities and the group with normal coagulation function.Results:After propensity score matching, there were 105 patients in each group, with a puncture success rate of 100% in both groups. The pathology qualification rate was 100% for all samples.Intraoperative bleeding occurred in 78 cases (74.3%, 78/105) in the coagulation function abnormalities group and in 64 cases (61.0%, 64/105) in the normal coagulation function group, with a statistically significant difference between the two groups ( P=0.006). Postoperative bleeding occurred in 3 cases (2.9%, 3/105) in the coagulation function abnormalities group and in 0 case in the normal coagulation function group, with no statistically significant difference between the two groups ( P=0.081). Conclusions:The use of the coaxial needle technique for percutaneous liver biopsy in patients with coagulation function abnormalities not only allows for obtaining an adequate tissue sample but also demonstrates good safety.

Objective To evaluate the application value of fusion imaging in intraoperative instant curative effect evaluation of thermal ablation for primary liver cancer (liver cancer). Methods Forty-six patients with liver cancer (71 lesions in total) undergoing ultrasound-guided thermal ablation in the Third Afifliated Hospital of Sun Yat-sen University between December 2014 and March 2015 were recruited in this prospective study. Forty-two patients were males and 4 were females, aged between 36 and 82 years with a median age of 54 years. The informed consents of all patients were obtained and the local ethical committee approval was received. After thermal ablation, clinical efficacy was preferentially assessed by contrast-enhanced ultrasound (CEUS)-computed tomography (CT)/magnetic resonance imaging (MRI) fusion imaging technique for all liver cancer lesions. If the fusion imaging was not successfully performed, simple CEUS was utilized for evaluation. According to the evaluation methods, the patients were divided into the fusion imaging group and CEUS group. The lesion size, supplementary and complete ablation rates in two groups were observed. The lesion diameter between two groups was compared using Z test and the ratio was compared using Chi-square test or Fisher's exact probability test. Results Fusion imaging was utilized for instant curative effect evaluation in 25 patients with 31 lesions, and simple CEUS was used for evaluation in 26 cases with 40 lesions. In the fusion imaging group, 58%(18/31) of the lesions were≥20 mm in diameter, signiifcantly higher compared with 30%(12/40) in the CEUS group (χ2=5.638, P<0.05). The supplementary ablation rate in the fusion imaging group was 52%(16/31), signiifcantly higher than 22%(9/40) in the CEUS group (χ2=6.489, P<0.05). The complete ablation rate was 100%(31/31) in the fusion imaging group and 95%(38/40) in the CEUS group , and no signiifcant difference was observed (P=0.501). Conclusions Both fusion imaging and simple CEUS are important methods for intraoperative instant curative effect evaluation. Fusion imaging has higher accuracy for the relatively large lesions and help to enhance the complete ablation rate.