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 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 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 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 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.

ObjectiveTo verify the feasibility and the accuracy for the biopsy of targets not visible on sonography but shown on CT in a phantom by using real-time virtual navigation system(RVS).Methods The tissue mimicking phantom,made of gel,contained 30 red spheres which were 10 mm in diameter,randomly placed.These spheres were invisible on sonography,but visible on CT.A junior operator and a senior operator performed the biopsy respectively,and each sphere was biopsied once guide by both RVS and conventional ultrasound for each operator.The red dye in thebiopsied sample meant successful performance.The success rate of biopsy and the length of the red dyed sample were recorded.Results There was no statistically difference between the performance results of the two operators.The success rate and the median length of red dyed sample biopsy of RVS were respectively 96.7％ (58/60) and 7.5 mm (rang,6-9 mm) which were statistically higher and longer than that of conventional ultrasound,43.3％(26/60) and 0 mm(rang,0 - 5 mm) ( P ＜0.05).ConclusionsBiopsy guided by RVS for the target invisible to ultrasound is a feasible and accuracy method,which will be a new guided method for interventional ultrasound.

Objective To investigate the role of intra-operative and percutaneous three-dimensional contrast-enhanced ultrasonic cholangiography (3D-CEUSC) in the diagnosis of biliary anomalies. Methods Diluted SonoVue, an ultrasonic contrast agent, was injected into the cystic duct of 13 living liver donors via a cannula for intra-operative 3D-CEUSC, while injection via a T tube or a PTCD tube were done in 14 patients for percutaneous 3D-CEUSC. The maximum branching order of the intra-hepatic bile ducts, the percentages of display of the first-, second-, and third-order intra-hepatic bile ducts, and the rates of detection of biliary anatomical anomalies were evaluated. Results The median of the maximum branching order of the intra-hepatic bile ducts shown was fourth-order on intraoperative 3D-CEUSC and third-order on percutaneous 3D-CEUSC, respectively. The difference was significant (P=0.01). From the first- to the third-order of intra-hepatic bile ducts, the percentages of display for intra-operative 3D-CEUSC were 100% (23/23), 96.2% (50/52) and 82.7% (86/104),respectively, while they were 100% (24/24), 94.6% (54/56) and 60. 7% (68/112) for percutaneous 3D-CEUSC. The differences were not significant when comparing the first- and the second-order branches of intra-hepatic bile ducts as shown either on intra-operative or percutaneous 3D-CEUSC (P=1).The percentages of display of the third-order branches using intra-operative 3D-CEUSC was higher than that of percutaneous 3D-CEUSC (P＜0. 0001). Three biliary anatomical anomalies were detected by intra-operative 3D-CEUSC and 4 anomalies were detected by percutaneous 3D-CEUSC. All of these anomalies were confirmed by X-ray cholangiography. Conclusion Both intra-operative and percutaneous 3D-CEUSC could diagnose biliary anatomical anomalies accurately. These procedures may become important techniques to evaluate the biliary anatomy in hepatobiliary surgery pre-operatively or intraoperatively.

Objective To determine the feasibility and safety of radiofrequeney(RF)ablation of entire prostate guided and monitored by contrast-enhanced transrectal ultrasound(CE-TRUS)in canine model.Methods Contrast ultrasound-guided RF ablation of entire prostate was preformed transrectally using Cool-tiptm electrodes in 7 normal canines under general anesthesia.The urethra/bladder and rectum were protected by infusion of cold distilled water through a Foley catheter and injection of cold distilled water into the prostate-rectum space,respectively.CE-TRUS findings were compared with TTC-stained pathologic results.Results All the 7 canines tolerated the ablation procedures.CE-TRUS clearly demonstrated hypoechoic thermal lesions as avascular/nonperfusion areas.The average number acquired for entire prostate ablation was 4.3(3 to 6).The average ablation volume achieved on pathology was 96.55%.There was no statistically significant difference when compared average ablative volumes between CE-TRUS and TTC-stained pathology[(9.16±5.20)cm3 vs(8.62±3.13)cm3,P=0.583].The coefficient correlation was 0.94(P=0.002).No thermal related injuries were found in anv of the bladder and rectum.The thermal related inj uries of the urethra were less than 1/4 quadrant.Conclusions It is feasible to ablate the entire prostate using RF thermal energy under CE-TRUS guidance.CE-TRUS plays a key role for achieving entire prostate ablation.The urethra and rectum can be protected by cooling of these structures during the procedure.