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 analyze the double contrast-enhanced ultrasonography (DCUS) features of periamupullary carcinoma for enhancing the ultrasound diagnostic value of the disease.Methods The DCUS and clinical data of 40 patients with periampullary carcinoma confirmed by histopathology were reviewed.Results (1) The displaying rate of the lesions and the judgment of lesion location was statistically higher on DCUS than that of ordinary ultrasound (P ＜ 0.05).(2) DCUS features of periampullary carcinoma:the size of most lesions was less than 30 mm except for 1 case in which no lesion was found; In 100％ (39/39) of the lesions,the morphology did not change with duodenum movement ; In 64.1％ (25/39) of lesions hyperenhancement or isoenhancement was displayed in the arterial phase,with low enhancement in the venous phase; In 87.2％ (34/39) of lesions homogeneous enhancement was displayed; In 95％ (38/40) the bile ducts were moderately or severely dilated.The lesion locations and whether the lesions projected into the duodenal cavity or not were statistically different between the three different types of periampullary carcinoma (P ＜ 0.05).The lesions projected into the duodenal cavity of duodenum were more commonly seen in papillary carcinoma and ampullary carcinoma than distal common bile duct carcinoma.The lesion size,whether the lesion morphology changed or not with duodenum movement,enhancement level,enhancement homogeneity,the degree of bile duct dilatation,whether there was pancreatic duct dilatation or not were not statistically different between the three different types of periampullay carcinoma (P ＞ 0.05).Conclusions DCUS is an effective way to show periampullay carcinoma,and is helpful to diagnose periampullary carcinoma and distinguish the three different types of periampullary carcinoma.

Objective To analyze the reasons of focal liver lesions that difficult to detect by conventional ultrasound ultrasound-CT/MR fusion imaging.Methods 101 lesions which were confirmed by pathology or clinical diagnosis standards were recruited in the research.All of them were difficult to detect by conventional ultrasound but CT/MR display clearly.Ultrasound-CT/MR fusion imaging was used to observe the size,location and internal echo of the lesions,as well as the background of the surrounding liver parenchyma.Results All cases were successfully registrated,the registration time were 2-6min [(4.1 ±0.6)min].For these 101 lesions,93.1％(94/101) of which the diameter ≤20 mm,56.4％ (57/101) were located in hepatic segments near the diaphragm (such as S2,S4,S7,S8),78.2％ (79/101) were internal isoecho,and 79.2％(80/101) in the background of liver cirrhosis.Conclusions The important reasons that focal liver lesions detected difficult by conventional ultrasound includes:lesion size,location,internal echo and the hepatic background.

This paper introduced the necessity, background, principle, content, function of construction of teaching resource database of blood disease testing technology and its role played in teach-ing reform. Construction of teaching resource database made up for the insufficiency of blood disease test-ing technology in teaching time and resource, explored more scientific learning mode and teaching meth-ods and strengthened the cooperation between part-time teachers and professional teachers of blood dis-ease testing technology courses.

Objective To evaluate the feasibility and accuracy of three-dimensional ultrasound (3DUS) automatic image fusion based on hepatic vessel in clinical application.Methods Forty pairs of 3D ultrasound volumetric images from 10 healthy volunteers were acquired and enrolled in the study,including 10 pairs of each following lobe of the liver:left lateral lobe,left medial lobe,right anterior lobe and right posterior lobe.3DUS automatic registrations were performed based on hepatic vessel.The technical successful rate and accuracy of the image fusion using the 3DUS data from four hepatic lobes were observed and compared.Results Thirty-six pairs of volumetric data were successfully fused together by automatic registration.The technical successful rate was 90％ (36/40) and the registration error distance was 1.48 mm (0.98-2.76 mm).There were no statistical differences in the successful rate for the four different hepatic lobes (P =0.891),but the registration error of right anterior lobe was less than left lateral lobe of liver (P =0.014).Conclusions The new technology of 3DUS automatic registration based on hepatic vessel was feasible and reliable,and it has a wide prospect in future clinical application.

Objective To compare the accuracy,convenience and repeatability of 3DUS-US and CT-US image fusion technology based on electromagnetic positioning.Methods A tissue-mimicking phantom was established and used to obtain ultrasound or CT volume images.Two different operators performed 3DUS-US and CT-US image fusion and repeated 10 times,respectively.The success rate,the registration error distance and fusion time of two techniques were recorded and compared between the different operators.Results The ultrasound and CT images of the phantom and its stability could meet the demands of this experiment.3DUS-US and CT-US image fusions were successful.The registration error distance of 3DUS-US image fusion was (1 .70 ± 0.42)mm and fusion time was (76.00 ± 9.99)s,they were obviously superior to CT-US (P = 0.014,P < 0.001 ).There were no significant differences between the two operators in the registration error distance and fusion time of 3DUS-US (P =0.508,P =0.5 1 7).But the registration error distance of CT-US image fusion in experienced operator was lower than the junior (P =0.009),and fusion time had not statistical difference between the two operators (P =0.234).Conclusions The technique of 3DUS-US automatic image fusion based on electromagnetic positioning has advantages of convenience and no experiential dependence comparing with CT-US in the phantom experiments,so it is worthy of being widely popularized in clinical application.

Objective To discusse the feasibility and application value of the computer-assisted liver cancer ablation planning based on the three dimensional ultrasound.Methods Forty three-dimensional ultrasound images of 39 patients with 40 tumors'maximum diameter between 21 to 70 mm were collected and then acquired image segmentation and visualzation.The computer-assisted liver cancer ablation planning based on three dimensional ultrasound was comparied with the artificial ablation planning based on two dimensional ultrasound to find out the differences in the success rate,damage rate,time-consuming and the number of insertions between these two methods.Results Compared with the artificial ablation planning based on two dimensional ultrasound,the computer-assisted liver cancer ablation planning had a higher success rate(92.31% vs 53.85%,P =0.000),lower damage rate(7.50% vs 25.00%,P =0.034),shorter time-consuming(44.0 s vs 263.0 s,P =0.000)and less insersion times(3 vs 4,P =0.009).Conclusions The computer-assisted liver cancer ablation planning based on three dimensional ultrasound is more efficient and safety than the traditional way.

Objective To evaluate the feasibility and accuracy of three-dimensional ultrasound-ultrasound (3DUS-US)automatic image fusion technology based on electromagnetic positioning.Methods The experimental phantom was constructed to acquire ultrasonic images by agarose gel and additives,which was used as the experimental object.3DUS imaging with free-hand and real-time ultrasound imaging automatic registrations were performed based on electromagnetic positioning.To investigate the effect of 3DUS-US image fusion under different scanning speed by free-hand,the fast and slow groups were designed. In addition,a junior operator and a senior operator performed 3DUS-US automatic registrations,and recorded the operating time and registration error,respectively.The repeatability between two operators was analyzed.Results The macroscopic appearance,stability and ultrasonic image of the phantom met the demand of this research.The success rate of 3DUS-US automatic image fusion technology was 100%(40/40).The slow group's registration error distance was (1 .44 ± 0.64)mm,which was obviously lower than the fast group's (2.56±0.53)mm,the difference was statistically significant (P <0.001).There were no statistically differences of the registration error and operating time between the two operators (P =0.508,P = 0.5 1 7 ).Conclusions The technology of 3DUS-US automatic registration based on electromagnetic positioning was feasible and accurate,which is worth applying into the clinical treatment.

Objective To evaluate the clinical value of CT/MR-contrast enhanced ultrasound (CEUS) image fusion in immediate assessment for hepatocellular carcinoma (HCC)ablation.Methods Patients diagnosed with HCC to receive ablation therapy were randomly divided into two groups.The ablation for each patient was performed according to their pre-ablation plan.Immediate assessments for the ablation were performed using CT/MR-CEUS image fusion (IF group)and CEUS (CEUS group)separately and whether the need for additional ablations was decided and performed during the therapy.The therapy efficacy was evaluated with enhanced CT or MR 1 month after each complete ablation treatment.Results There were 101 patients with 131 nodules in IF group,and 15.1% of the nodules needed additional ablation according the immediate assessment during the therapy.The complete ablation rate of IF group was 99.2%(125/126).On the other hand,there were 93 patients with 122 nodules in CEUS group,and 4.2% of the nodules needed additional ablation according the immediate assessment during the therapy.The complete ablation rate of CEUS group was 94.2% (113/120).IF group has significantly higher additional ablation rate and complete ablation rate than CEUS group (P <0.05).Conclusions CT/MR-CEUS image fusion can further improve ablation efficacy with accurate intraoperative evaluation and guidance of additional ablation compared with CEUS.

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 .