ObjectiveTo evaluate the value of uhrasonography for arthrocentesis in the hip and the advance of the femoral head/acetabulum as the puncture location in patients without sonographically obvious joint effusion.Methods Forty-three patients diagnosed with ankylosing spondylitis or osteoarthritis were included,82 hip joints were involved and received ultrasounded-guided intra-articular injections.The puncture site was the joint space between the femoral head and the acetabulum.The times,depth,procedure time,side effects and complications of each injection were recorded.ResultsAll 82 hips could be explicitly displayed.The depths from the skin surface to the joint space were (3.4 ± 0.9)cm (left)and (3.1 ± 0.8)cm (right),respectively.Overall,100％ of hip joints were punctured successfully,and 95.1％ of them were succeeded with the first arthrocentesis.The procedure time was (287.9 ± 45.8) s.No side effects or complications were observed.ConclusionsThe sonographic technique could be used as a primary method of image guidance for performing hip arthrocentesis and the joint space between the femoral head and the acetabulum could be a choice of target location for the patients without joint effusion.

Objective To explore clinical significance of constriction of fetal ductus arteriosus diagnosed by echocardiography.Methods Seventy-one cases with constriction of fetal ductus arteriosus (DA) and one fetus with premature closure of DA were detected by fetal echocardiography among 2380 singleton fetuses.The echocardiographic characteristics and clinical outcomes were reviewed and analyzed.Results Of 71 cases with constriction of fetal DA,58 cases were found with right heart enlargement,12 cases with tricuspid regurgitation,8 cases with arrhythmia and 1 case with pericardial effusion.The echocardiographic characteristics showed narrowed diameter of DA,dilatation of pulmonary artery and descending aorta was also noted,DA was markedly curved.The peak systolic velocity(PSV) and enddiastolic velocity(EDV) in the ductus arteriosus measured by pulsed Doppler echocardiography increased (PSV≥ 180 cm/s,EDV≥35 cm/s).All cases were confirmed normal by neonate echocardiography.Conclusions Prenatal echocardiography plays important role in diagnosis of constriction of fetal DA.Early diagnosis and intimate follow-up can direct clinician to offer suitable consultation for parents and management for fetuses.

BACKGROUND:The experimental animal models can be used to in-depth investigate the effect of ultrasound and contrast-enhanced ultrasound in the diagnosis and treatment of ischemic biliary lesions. But there is no report on the phase timing standard of rabbit model contrast-enhanced ultrasound that used in various hepatobiliary diseases. OBJECTIVE:To investigate the ultrasonic appearance of normal rabbit biliary ducts with conventional ultrasonography and contrast-enhanced ultrasonography, and the criterion of contrast-enhanced ultrasonography phase timing of rabbit liver. METHODS:The conventional ultrasonography of hepatobiliary system was performed on 10 healthy New Zealand rabbits, and contrast-enhanced ultrasonography was performed on duct wal s that displayed in conventional ultrasonography, then the features were analyzed. RESULTS AND CONCLUSION:(1) The bile duct of normal New Zealand rabbits showed a portal to biliary caliber ratio of 3.59±0.54. (2) The detection rates of common and middle lobe bile ducts were significantly higher than that of lateral lobe bile ducts on both conventional ultrasonography and contrast-enhanced ultrasonography. (3) The phases of contrast-enhanced ultrasonography of normal rabbit liver were divided into arterial phase (10-20 seconds), portal phase (21-30 seconds) and late phase (31-180 seconds). The normal duct wal presented hyper-enhancing at arterial phase and persistent iso-enhancing at portal and late phases. The establishment of these parameters of normal New Zealand rabbits not only lays a foundation for the application of contrast-enhanced ultrasonography on biliary ischemia but also expands to other hepatobiliary models.

Objective To prepare targeted nanoscale lipid ultrasound contrast agent and study the targeting function in vitro.Methods After the biotinylated monoclonal antibody Herceptin was prepared,the biotinylated degree and immunological activity were determined.Then biotinylated antibody was attached to the surface of nanoscale lipid ultrasound contrast agents by avidin-biotin system to prepare the targeted nanobubbles.The targeting function was studied by observing the combination ability of the targeted nanobubbles with SKOV3 cells in vitro,non-targeted nanobubbles as controls,and observing ultrasound imaging in vitro.Results About 16 biotin molecules were coupled to each antibody in average,and the immunological activity of the biotinylated antibody didn't decrease compared with the free one(P ＞0.05).SKOV3 cells were combined firmly and surrounded regularly by red dyed targeted nanobubbles,while control groups were negative.Ultrasound imaging could be significantly enhanced by targeted nanobubble binding to SKOV3 cell slides,the other two control groups were negative.Conclusions Nanoscale ultrasound contrast agent and antibodys can be combined firmly by avidin-biotin system to produce the targeted nanobubbles,which have strong targeting function in vitro and significantly enhanced ultrasound signal.

Objective To evaluate the value of contrast-enhanced ultrasound (CEUS) in diagnosing ischemic-type biliary lesion (ITBL) and analyze the relation between the enhancement patterns of bile duct wall of ITBL and its outcome.Methods 36 patients confirmed with ITBL (24 cases),anastomotic biliary stricture (3 cases),cholangitis (4 cases),biliarysludge (1 cases),and acute rejection (4 cases),who underwent CEUS examination,were enrolled in this study.The images were retrospectively analyzed in consensus by 2 readers.After reviewing the images,the readers were asked to make a diagnosis of ITBL.The diagnostic standard was hypo-or non-enhancement of hilar bile duct wall in arterial phase on CEUS.Results The diagnostic sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 66.7％,83.3％,72.2％,88.9％,and 55.6％ for reader 1;62.5％,83.3％,69.4％,88.2％,and 52.6 ％ for reader 2,respectively.The interobserver agreement was good (κ =0.83).In 24 ITBL patients,the ratio of mortality or retransplantation with non enhancing hilar bile duct wall in arterial phase was much higher than that with enhancing hilar bile duct wall (non-enhancement 54.5％,hypo-enhancement 20％,hyper-or iso-enhancement 12.5％).Conclusions CEUS had diagnostic value of ITBL.Non-enhancing hilar bile duct wall in arterial phase on CEUS predicated the poor outcome.

Objective To explore the clinical application and diagnostic efficiency of two-dimensional shear wave elastography (2D-SWE) in assessing liver fibrosis of patients with viral and non-viral hepatitis. Methood Seventy-three patients with viral hepatitis and sixty with non-viral hepatitis scheduled for liver biopsy in the third Affiliated Hospital, Sun Yat-Sen University from April, 2011 to January, 2013 were enrolled in this study. The Young's modulus in different fibrosis stages, correlation coefficients of liver fibrosis level and area under receiver operating characteristic curve (ROC) were compared between patients with viral and non-viral hepatitis respectively. Results The hepatic Young's modulus of patients with viral and non-viral hepatitis in S0-1, S2-3, S4 were 6.1(4.8-6.6)kPa,7.4(6.0-8.4)kPa,10.3(7.6-14.0)kPa, and 10.7(8.0-13.5)kPa,24.7(17.4-32.1)kPa,26.8(16.5-31.7)kPa, respectively. The difference of Young's modulus between viral and non-viral hepatitis in S0-1 were statistically significant (Z=-3.45, P=0.001), while not in S2-3 and S=4 (Z=-0.40, -0.06, P=0.686, 0.956). Correlation coefficients of liver fibrosis with 2D-SWE in viral and non-viral hepatitis are 0.964,0.817 ( both P=0.000 ) with statistically significant difference (Z=2.42, P=0.015). The area under ROC for S≥2 and S=4 in viral and non-viral hepatitis were 0.964 and 0.930,0.817 and 0.906 respectively. The comparison was significantly different for S≥2 (Z=-2.47, P=0.014), while not for S=4 (Z=-0.502, P=0.616). Conclusion In liver fibrosis assessment, the diagnosis efficiency of 2D-SWE in patients with viral and non-viral hepatitis was different and dependent on fibrosis stage.

Objective To tested the passive targeting of nanobubbles penetrating tumor vascular endothelial cells gap.Methods Twenty female BALB/c nude mice subcutaneously bearing human ovary cancer SKOV3 were devided into two groups:group A (ultrasound imaging) and group B (frozen sections:B1 and B2).DiI labled nanobubbles and microbubbles were prepared and adjusted into the same concentrations.Group A:Microbubbles and nanobubbles of 35 μl were injected into the tail vein of every mouse respectively (1.5 h interval).Ultrasound imaging were acquired.Group B:Nanobubbles and microbubbles of 10 μl were injected into the tail vein of mice in Group B1 and Group B2 respectively.Heart perfusion by PBS or 0.9％ normal saline was carried out 1.5 h after bubbles injection to clear the free bubbles in blood circulation.And the tumor and muscle of right lower limb were immediately cut off for frozen slices (3 μm),which were stained by Hoechst 33342 to mark the nucleus.Images were obtained with a confocal microscope.Results In vivo ultrasound imaging,the time to peak and clearance time of nanobubbles were longer than those of microbubbles,whereas the intensity of enhancement was lower than microbubbles.Frozen sections showed:with the confocal laser scanning microscopy imaging,quite a number of DiI-labeled nanobubbles existed in the intercellular space of SKOV3 tumor,whereas there were few nanobubbles in skeletal muscle sections.In the control,rare DiI-labeled microbubbles were observed in tumors and skeletal muscle.Conclusions Self-made lipid nanobubbles were small enough to pass through the tumor vascular endothelial gap,namely achieve the tumor passive targeting.

OBJECTIVETo compare the abilities of transient elastography (TE) versus real-time tissue elastography (RTE) for assessing liver fibrosis in patients with chronic liver disease.

METHODSNinetytwo patients with chronic liver disease were enrolled in the study, and included 77 cases of chronic hepatitis B, 4 cases of chronic hepatitis C, 4 cases of autoimmune liver disease, 2 cases of primary biliary cirrhosis, I case of abnormal bile duct development, and 4 cases of unknown etiology.All patients were assessed by both TE and RTE in a single day.The correlation coefficient of liver fibrosis level and the receiver operating characteristic (ROC) curve of S more than 2 and =4 of TE and RTE were determined.The values were compared using findings fiom pathological analysis as reference.

RESULTSThe correlation coefficient of liver fibrosis level was significantly higher for TE (r =0.755, 95% CI:0.651-0.831, P =0.000) than for RTE (r=0.481, 95% CI:0.306-0.624, P =0.000) (Z=3.07, P =0.002).The areas under the ROC curves for S more than 2 and =4 were 0.903 and 0.740 for TE and 0.915 and 0.786 for RTE, respectively, indicating that the performance of TE was superior to that of RTE.

CONCLUSIONTE was superior to RTE for assessment of liver fibrosis.

Autoimmune Diseases ; Elasticity Imaging Techniques ; Hepatitis B, Chronic ; diagnostic imaging ; Hepatitis C, Chronic ; diagnostic imaging ; Humans ; Liver Cirrhosis, Biliary ; diagnostic imaging ; ROC Curve

Objective To analyze the optimal threshold of Doppler ultrasonography(DUS)in the diagnosis of hepatic artery stenosis(HAS)after liver transplantation and propose the diagnostic criteria of CT angiography(CTA) or digital subtraction angiography(DSA)for patients with tardus parvus waveform(TPW)in combination with liver dysfunction. Methods Clinical data of 171 patients undergoing liver transplantation, postoperative conventional DUS, liver function test, CTA or DSA were collected. The optimal threshold of resistance index(RI)and systolic acceleration time (SAT)for the diagnosis of HAS were determined by multi-level likelihood ratio(MLR). Different diagnostic criteria were established and the diagnostic efficacy was statistical y compared. Positive TPW was defined as the diagnostic criterion with low confidence, positive TPW+liver dysfunction as the moderate confidences, and positive TPW+liver dysfunction or positive TPW+optimal threshold as the high confidence. Results MLR revealed that RI<0.4 and SAT>0.12 s were the optimal threshold for the diagnosis of HAS. The specificity of diagnostic criteria with moderate and high confidence was significantly higher compared with that of the low confidence(P<0.05). Moreover, the false-positive rate was significantly decreased(P<0.05). The sensitivity of diagnostic criterion with moderate confidence was significantly lower than those of low and high confidence(both P<0.05), whereas the sensitivity did not significantly differ between the diagnostic criteria with low and high confidence(P>0.05). Conclusions For patients with positive TPW detected by DUS after liver transplantation, the optimal threshold of diagnostic criteria combined with liver dysfunction contribute to appropriate clinical decision-making for clinicians.

Objective To evaluate the clinical efficacy of early diagnosis by contrast-enhanced ultrasound (CEUS) combined with mesenchymal stem cell (MSC) therapy in the treatment of biliary ischemia after liver transplantation. Methods Clinical data of 9 recipients presenting with biliary ischemia detected by CEUS within 4 weeks after liver transplantation and diagnosed with non-anastomotic biliary stricture (NAS) within postoperative 1 year were retrospectively analyzed. In the conventional treatment group, 4 recipients were treated with conventional treatment including liver protection, cholagogic therapy and interventional therapy. In MSC treatment group, 5 recipients received intravenous infusion of MSC at 1, 2, 4, 8, 12 and 16 weeks after biliary ischemia detected by CEUS on the basis of conventional therapy. The interventional treatment and clinical prognosis within 1 year after liver transplantation were analyzed between two groups. Results Two recipients in the MSC treatment group required interventional therapy, which was initially given at 7-9 months after liver transplantation for 1-2 times. All recipients in the conventional treatment group required interventional therapy, which was initially delivered at postoperative 1-3 months for 2-6 times, earlier than that in the MSC treatment group. Within 1 year following liver transplantation, diffuse bile duct injury occurred in 2 recipients in MSC treatment group, and no graft dysfunction was observed. In the conventional treatment group, all recipients developed diffuse bile duct injury, and 2 recipients presented with graft dysfunction. Conclusions Early diagnosis of biliary ischemia after liver transplantation by CEUS combined with MSC therapy may delay and reduce the requirement of interventional therapy for NAS, and also improve clinical prognosis of the recipients.