Objective Using coded harmonic angiography to observe hepatocellular carcinoma blood perfusion features,further assess this modality clinical value in qualitative diagnosis of liver malignant tumor.Methods Through left forearm vein bolus injection of fluorine-carbon contrast agent,35 patients with 41 hepatocellular carcinoma lesions were examined with coded harmonic angiography,intratumoral vessel enhanced time,vascularity,blood perfusion were observed.All patients were simultaneously videotaped before and after contrast.Results It was about 15～20 s after the injection of contrast agent when the enhancement of tumor had just commenced,peak time about 60～90 s and persistence time about 240～300 s.Lesions were more obviously enhanced than normal liver tissue,several tumor vascularity was displayed from border to center,contrast agent gradually centripetal filled-in,formed "weeping-willow" echo.Pressed and rimlike peripheral vessel developments were earlier than normal liver tissue.Conclusions Coded harmonic angiography could real-timely display hepatocellular carcinoma blood perfusion,which has an important clinical value in qualitative diagnosis of liver malignant tumor.

Objective To evaluate the clinical value of artificial pleural effusion for percutaneous microwave ablation of liver cancer in the hepatic dome. Methods 28 difficult cases (total 34 lesions), all lesions were located in the hepatic dome and covered by lung. Infused with artificial pleural effusion by ultrasound real-time monitoring before percutaneous ultrasound-guided microwave ablation. The amount of artificial pleural effusion, the technique successful rate,the rate of lesions revealed, local treatment response and complications had been observed. Results The amount of artificial pleural effusionwas 200-1 000 mL [(388 ± 107)mL]. The technique successul rate of artificial pleural effusion was 100% (28 / 28), the rate of lesions revealed was 85.3%(29 / 34), the other 5 isoechoic lesions were revealed by contrast-enhanced ultrasound. All the 34 lesions was ablated completely, the complete ablation rate was 100%(34 / 34). the rate of complications was 2.9%(1 / 34), 1 patient was found a small amount of intraperitoneal hemorrhage after ablation. Conclusions Artificial pleural effusion assisted percutaneous microwave ablation of liver cancer in the hepatic dome is a safe , effective treatment, it broadened the percutaneous microwave ablation therapeutic range, and should be more widely used in clinically.

Objective To explore the feasibility of evaluation of hepatic fibrosis using the tissue dispersion quantitative analysis software based on ultrasonic elastography. Methods Forty-six chronic liver disease patients were examined by tissue dispersion quantitative analysis software. There were 11 characteristic quantities of elastography imaging obtained by the tissue dispersion quantitative analysis software,including average relative strain value,standard deviation of relative strain value,area ratio of low-strain region ( AREA%) , complexity, kurtosis, skewness, contrast, entropy, inverse different moment,angular second moment,correlation. The 11 characteristic quantities were compared with pathological stages of hepatic fibrosis. Results The characteristic quantities had statistically significant differences except kurtosis and correlation in the analysis of variance and correlational study with pathological stages ( P < 0.05). The AREA% had the highest related coefficient ( r = 0.725). The ROC curve was made by AREA% ,the areas under the ROC curve were 0. 865 ,0. 880 and 0. 886. Conclusions The tissue dispersion quantitative analysis software is helpful in the evaluation of stages of hepatic fibrosis. The AREA% has the highest relationship with pathological stages of hepatic fibrosis and good diagnostic value.

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 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 evaluate virtual navigation assisted contrast-enhanced ultrasound(VN-CEUS) by comparing VN-CEUS with routine CEUS in detecting focal liver lesion(FLL) invisible in B-mode ultrasound(BUS).Methods Forty-seven FLLs invisible in BUS were identified by CT/MR,and received VN-CEUS and routine CEUS respectively.Results The detection rate of VN-CEUS and routine CEUS were 78.7%(37/47) and 36.2%(17/47),the former was much higher than the later (P<0.01).In all the cases,fusion of CT/MR with ultrasound was achieved successfully and average time for image fusion was 5 min.compared with routine CEUS,VN-CEUS could more easily find FLLs shadowed by lung or ribs,FLLs in inhomogeneous liver background,and FLLs with brief or inapparent abnormal enhancement.ConclusionsVN-CEUS can greatly improve the detection rate of FLL that was invisible in BUS.

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.

efore graft harvesting in living donor liver transplantation.

Objective To compare the values of biochemistry, ultrasonography ( US) , computed tomography(CT) and proton magnetic resonance spectroscopy ('H MRS) in the quantitative diagnosis of fatty liver. Methods Forty-five healthy New Zealand rabbits were enrolled in the study. Hepatic steatosis models were established by giving high fat, high sugar diet with drinking water containing five percent ethanol. Eighteen variable indexes were measured by biochemical examination, US,CT and ' H MRS. ROC analysis and Z test were used to compare the diagnostic efficacy of different clinical examinations. Results Among eighteen variable indexes,serum TC,ultrasound attenuation coefficient,liver CT value and ' H MRS fat peak area had the highest degree of relationship by biochemical examination, US, CT, ' H MRS in diagnosis of fatty liver, correlation coefficients were 0.886,0.483, -0. 764, 0. 558, and areas under curve were 0. 981, 0. 581, 0. 810, 0. 713, respectively. There were significant differences in areas under curve between every two groups except 'H MRS fat peak area and ultrasound attenuation coefficient, liver CT value. Conclusions The diagnostic values of imaging modalities in the hepatic steatosis grade, their order is CT >'H MRS> US; Serum TC maybe have important diagnostic value in evaluating hepatic steatosis grade,this is very worth further studying.

Objective To investigate the feasibility of three-dimensional contrast-enhanced ultrasonic cholangiography(3D-CEUSC) in isolated porcine liver specimens.Methods The lobes of 5 isolated porcine livers were taken as scanning units and the lobular bile branches were cannulated.3D-CEUSC was performed after the administration of diluted ultrasonic contrast agents(SonoVue) through the cannula.The images were assessed in term of maximum visualization of branching orders and image quality.The coincidence of morphous was compared between 3D-CEUSC and cholangiagraphy using fluoroscopy.Results Fourteen lobular biliary branches were cannulated successfully in 5 isolated porcine livers.The maximum visualization of branching orders from the third- to first-order branches were 42.9% (6/14) ,42.9% (6/14), 14.2% (2/14) in sequence.The image quality was 21.4% (3/14) graded as well, 57.2% (8/14) as moderate, and 21.4% (3/14) as poor.Compare with cholangiagraphy using fluoroscopy, the coincidence of morphous was 42.9%(6/14) for well,42.9% (6/14) for moderate,and 14.2% (2/14) for poor.Conclusions 3D-CEUSC could be a new imaging method to evaluate the biliary anatomy.