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 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.

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 evaluate the clinical value of intraoperative image fusion assisted contrastenhanced ultrasound (CEUS) in real-time assessing the curative effect on radiofrequency ablation of hepatocellular carcinoma(HCC).Methods From November 2010 to August 2011,the patients with HCC which would accept radiofrequency ablation (RFA) in our hospital were divided into image fusion assisted CEUS group and conventional CEUS group.The HCC lesion in each group was named as difficult lesion if it was invisible in B-mode ultrasound,larger than 50 mm in diameter or the puncuture route was affected by lung,ribs or blood vessels.Ten minutes after RFA,two groups of patients were performed intraoperative image fusion assisted CEUS examination and conventional CEUS examination respectively.All the patients received CT/MRI one month after ablation to decide whether the HCC had been completely ablated.Difference of complete ablation rate of HCC was compared between the two groups as well as between the difficult lesions in each group.Results Forty-eight lesions in 39 patients were enrolled in image fusion assisted CEUS group including 19 difficult lesions.Sixty-eight lesions in 53 patients were enrolled in conventional CEUS group including 18 difficult lesions.No statistical difference was found between the two groups in lesion size,proportion of difficult lesions,proportion of lesions received TACE or RFA plus PEIT (P =0.052,P =0.136,P =0.185,P =1.000).Postoperation following-up results demonstrated that complete ablation rate of HCC in navigation assisted CEUS group(100 ％,48/48) was not statistically higher than that in conventional CEUS group(92.6％,63/68) (P =0.145).But the difficult lesions in navigation assisted CEUS group (100％,19/19) had statistically higher complete ablation rate than that in conventional CEUS group(72.2％,13/18) (P =0.020).Conclusions Intraoperative navigation assisted CEUS could real-time assess the curative effect on RFA of HCC,especially in the difficult lesions,and could be used as the beneficial supplement of the conventional CEUS.

Objective To demonstrate the feasibility and accuracy of the intellectual position(IP)technique used in ultrasound-guided biopsy.Methods Several red spheres,which were 10 mm in diameter and visible in ultrasound,randomly placed in the tissue mimicking gel phantom.The biopsy was performed by two operators respectively.Each operator chose 25 spheres,each of which were performed biopsy guided by IP technique,free-hand ultrasound and ultrasound with guide bracket.The red dye in the biopsied sample meant successful performance.The time spend in per biopsy target,the success rate of biopsy and the length of the red dyed sample of the three methods were recorded,and comparison was made among them.Results The median time took in biopsy guided by IP technique was 95(rang,80-110)s,which was longer than that of free-hand ultrasound-guide[30 (rang,22-42) s,P ＜0.001] and ultrasound-guide with bracket [20(rang,15-28)s,P ＜0.001].The success rate of biopsy guided by IP technique was 98.0％ (49/50)which was as well as that guided by ultrasound-guide with bracket(96.0％,48/50,P =0.558),better than free-hand ultrasound-guide(78.0％,39/50,P =0.002).The median length of red dyed sample biopsied guided by IP technique was 8.0 (rang,7.0-8.5)mm,which was longer than that of free-hand ultrasoundguide[6.0(rang,4.0-8.0)mm,P =0.003] and ultrasound-guide with bracket[7.0(rang,6.0-8.0)mm,P =0.003].There was no statistically difference between the two operators in length of red dyed sample and success rate of biopsy guided by IP technique(P ＞0.05).Conclusions Biopsy guided by IP technique is a feasible and accuracy method,which will become an effectively supplement of the ultrasound-guide with bracket.

Objective To study the enhancement patterns of hilar bile duct wall of ischemic-type biliary lesion (ITBL) on contrast-enhanced ultrasound (CEUS).Methods Eighteen healthy subjects,18 orthotropic liver transplantation (OLT) recipients without complications,and 36 patients,which were subdivided into 2 groups according to the final diagnosis:patients with (n =24) and without (n =12)ITBL,were enrolled in this study.The patients without ITBL had anastomotic biliary stricture (n =3),cholangitis (n =4),biliary sludge (n =1),and acute rejection (n =4),respectively.The images of baseline sonography and CEUS were retrospectively analyzed in consensus by 2 readers.The enhancement time and level of hilar bile duct wall,hepatic artery and liver parenchyma were recorded.Results Hilar bile duct wall became enhancing earlier than liver parenchyma in all of 4 groups.During arterial phase,hyper-or isoenhancing bile duct walls were present in most cases in the groups of healthy subjects,OLT recipients without complications and patients without ITBL.However,non-or hypo-enhancement of hilar bile duct wall were present in 16 (66.7％) ITBL patients,which is different from the other groups (P ＜0.05).Conclusions The main features of ITBL differing from the other groups were non-or hypo-enhancement of hilar bile duct wall in arterial phase.It may be a diagnostic index to apply in detecting ITBL with CEUS.

Objective To evaluate the effect and safety of combined treatment by laparoscopic cholecystectomy and subsequent ablation in patients with HCC adjacent to the gallbladder. Methods From June 2005 to June 2009,13 patients with HCC nodules( less than 3 cm) adjacent to the gallbladder were treated by ablation after laparoscopic cholecystectomy. The rate of complete necrosis as well as postoperative complications were also analyzed. Results All the patients showed complete necrosis of their tumor lesions after treatment by ablation subsequence of laparoscopic cholecystectomy. During the follow-up period( nearly 2 years), recurrent nodules appeared in other subsegments but not at the original site treated by ablation. Of note, no fatal complications were observed in all the ablation treated patients. Conclusion Combined treatment by laparoscopic cholecystectomy and subsequent PMCT was an effective and safe method for patients with small HCC which was adjacent to gallhladder.

Objective To evaluate the value of virtual navigation assisted 3-D contrast-enhanced ultrasound (VNA-3D-CEUS) in depicting ablative area and ablative margin after hepatocellular carcinoma radiofrequency ablation. Methods Sixty-one lesions in 51 patients were evaluated ablative area and ablative margin using VNA-3D-CEUS. The results were divided into three groups: (A) tumor was completely ablated and 5 mm ablative margin was achieved; (B) tumor was completely ablated but 5 mm ablative margin was not achieved; (C) tumor was not completely ablated. The technical successful rate of VNA-3D-CEUS,as well as the coincidence rate of complete ablation with contrast-enhanced MRI,was evaluated. The relation between local tumor progression and ablative margin was observed through follow-up. Results The technical successful rate of VNA-3D-CEUS was 78.7％ (48/61). Coincidence rate of complete ablation with contrast-enhanced MRI was 100％ (40/40). The local tumor progressions of group A and group B were 0/26 and 2/13. There was significant difference between A and B group( P =0.032). Significant correlation between local tumor progression and ablative margin was found ( r =- 1. 000, P ＜0. 001 ). Conclusions VNA-3D-CEUS could be a new method in accurately evaluating the ablative area and ablative margin after hepatocellular carcinoma ablation.

Objective To formed ranoscale ultrasound contrast agents loading PFOB by selfassembly of amphiphilic block copolymer for ultrasonic imaging in vivo and in vitro.Methods The biodegradable copolymer-poly(ethylene glycol)-b-poly (D, L-lactic acid) (PEG-PDLLA) self-assembled to form PFOB-loaded nanomicelle and nanovesicle with different PFOB concentration by solvent volatilization.The configuration and particle-sizing of resulting nanoparticles was determined,and their ultrasonic imaging in vitro and contrast-enhanced ultrasonography on subcutaneous tissue by focal injection in vivo were observed.Results In transmission electron microscope images, these micelles and vesicles appeared uniformly spherical with smooth surface.All the size distributions were narrow and mean diameters were from 404.3 to 475.8 nm using laser particle-sizing analyzer.In vitro and in vivo experiment showed that,the higher PFOB concentration, the more remarkable effect of ultrasound imaging.Especially, nanovesilces'ultrasonography effect was much better than nanomicelles' under same conditions.Conclusions PFOB-loaded nano-micelles and nano-vesicles prepared by solvent volatilization and self-assembly of PEG-PDLLA can obviously enhance ultrasound contrast and nanovesicle behaves better than nano-micelle.