Objective To evaluate the correlation between quantitative parameters of contrastenhanced ultrasound(CEUS) and microvessel density (MVD) of rabbit atherosclerotic plaques.Methods Twenty-six male New Zealand rabbits were damaged abdominal aortic by balloon expanded,fed with high fat 12 weeks later.Thirty two plaques were detected using conventional ultrasound examination.The maximum area,luminal area stenosis rate and the maximum thickness of each plaque were recorded.CEUS was performed on 32 plaques and enhancement images were offline analyzed quantitatively by ACQ software and the parameters such as arrival time(AT),time to peak(TTP),basic intensity(BI),and peak intensity(PI) were acquired.Enhanced intensity (EI) was calculated according to the formula:EI =PI- BI.Then the experimentalrabbitswerekilledforpathologicalexaminationandCD34monoclonalantibody immunohistochemical detection.MVD was counted under the microscope.The correlation between the parameters of CEUS and MVD was analyzed.Based on pathological findings,the plaques were divided into vulnerable plaques and stable plaques.ResultsEI and MVD of vulnerable plaques group were significantly higher than that of stable plaques group [EI:(26.36 ± 1.44) dB vs (23.90 ± 2.92)dB,t =- 3.243,P =0.001 ；MVD:(5.23 ± 1.16)/mm2 vs (2.47 ± 1.12)/mm2,Z =- 4.378,P ＜0.001].The maximum area,luminal area stenosis rate,the maximum thickness and PI,AT,TTP had no significant difference between two groups( P ＞0.05).The value of EI showed significant positive correlation with MVD ( r =0.676,P ＜0.001).ConclusionsEI can accurately evaluate the angiogenesis of rabbit atherosclerotic plaques,which can be regarded as a useful index to distinguish between vulnerable and stable plaques.

ObjectiveTo determine the correlation of real-time contrast-enhanced ultrasonography (CEUS) patterns and quantitative parameters with microvessel density (MVD) and vascular endothelial growth factor (VEGF) expression of breast tumors.Methods One hundred and five patients with 128 breast lesions(62 benign,66 malignant) underwent CEUS examination.CEUS patterns were analyzed and parameters were obtained by time-intensity curve analysis software.Immunohistochemical staining using anti-factor CD34 was performed to evaluated the MVD and VEGF expression was detected.Results All CEUS patternsweresignificantlyassociatedwithMVDandVEGFexpressionexceptboundary characteristics( P ＜ 0.05).The enhancement parameters showed that the time to peak was significantly faster in malignant tumors than that in benign lesions,and the peak intensity and area under the curve were significantly higher in malignant tumors than those in benign lesions( P ＜0.05).The time to peak,the peak intensity,area under the time-intensity curve were statistically correlated with MVD (P ＜0.05),the highest correlation was between the area and MVD( r =0.81,P ＜0.001).Only the area under the timeintensity curve was significantly associated with VEGF expression (P ＜ 0.05).Conclusions CEUS patterns and parameters of breast lesions are closely correlated with MVD,which can be used to evaluated the angiogenesis in breast tumors.

ObjectiveTo evaluate the clinical value of Young's modulus by supersonic shear wave elastography (SWE) in differential diagnosis of thyroid solid nod1ules.MethodsEighty-three patients with 113 solid nodules were examined by SWE.All the nodules were confirmed by pathology.According to Young's modulus,a receiver operating characteristic (ROC) curve was drawn,and it used to identify the value of optimal operating point for differential diagnosis of thyroid nodules.Results ① The mean of Young's modulus of benign nodules was (23.57 ± 9.35)kPa,which was significantly different from the valve of malignant nodules (43.73 ± 19.82) kPa ( t =6.31,P =0.00).(②) It showed that the optimal operating point of ROC curve as 27.49,with high sensitivity(93.2％),specificity(81.2％) and accuracy (85.8％).The area under ROC curve was 0.91.Conclusions SWE is a newly quantitative technique of ultrasonography,which is helpful to identify and distinguish in the differential diagnosis of thyroid nodules.

Objective To establish the reference ranges for fetal cardiac axis in the mid-second trimester and to evaluate the use of fetal cardiac axis in prenatal diagnosis.Methods 6744 unselected singleton pregnancies were enrolled from September 2008 to October 2010.Routine screening scan of second trimester and fetal echocardiography were performed at 18- 23+6 weeks gestation.Fetal cardiac axis was measured on the four-chamber view of the heart.Results The 6744 fetuses had a mean cardiac axis of (37.03 ± 6.10)°,ranging from 9.80° to 102.41°. Using above or below 95％ range of population (26.63° -49.40°) as a cut-off,there were significant difference of cardiac axis between normal group [(36.96 ± 5.91)°,P ＜0.01] and the group with heart defects [(43.12 ± 15.67)°,P ＜0.01],the group with intrathoricic anomalies or abdominal wall defect [(51.74 ± 15.97)°].ConclusionsThe reference ranges of fetal cardiac axis for local population in mid-second trimester may helpful for detecting congenital defects.Presence of an abnormal cardiac axis in the fetuses is associated with a substantial risk of congenital heart disease and/or other extra cardiac defects.

ObjectiveTo probe the value of transrectum ultrasound (TRUS) in evaluating the effect of new adjuvant therapy (NAT) in treating middle-low level rectal cancer (MLLRC).MethodsTRUS was used to examine 82 cases of MLLRC before and after NAT.All cases were pathologically confirmed.The results of TRUS before and after NAT were compared.ResultsThe diagnostic rate of TRUS in MLLRC was 97.6％(80/82).The up to down range and thickness of foci of 80 cases which were detected by TRUS before NAT showed different degree diminution after NAT( P ＜0.05).The number of lymph node around rectum decreased obviously ( P ＜0.05).Only the lymph nodes of 5 cases of all lymph nodes detected by TRUS before and after NAT showed dot flow signal.ConclusionsTRUS can clearly showed the MLLRC foci,internal flow signal and lymph nodes around rectum.This is of important value in evaluating the effect of NAT,choosing the therapeutic schedule and avoiding over therapy.

Objective To investigate the value of the intraoperative real-time three-dimensional transesophageal echocardiography (RT 3D-TEE) in therapeutic application of surgery for the mitral valve prolapse.Methods Thirty-five patients underwent surgical treatment were diagnosed as mitral valve prolapse by 2-dimensional transthoracic echocardiography (2D-TTE),with or without ruptured chordae tendineae.RT 3D-TEE was performed for assessing the segment of prolapse and its complications before cardiopulmonary bypass and after heart resuscitation respectively.The echocardiographic results were compared with the surgical findings.Results The accuracy of RT 3D-TEE to identify segments with prolapse was significantly higher than that of 2D-TTE (91.4％ vs 82.9％,P =0.003).RT 3D-TEE was more accurate than 2D-TTE for identifying ruptured chordae tendineae,vegetation and thrombus since higher sensitivity,specificity and Youden index.Among all 35 patients,valvuloplasty was performed in 28 cases,whereas,only 7 cases underwent replacement of prosthetic valves.Three patients were benefited by accurate evaluation of therapeutic effect using RT 3D-TEE in time.ConclusionsIntraoperative RT 3D-TEE can be used to provide “ surgical view”,acquired adequate valuable information of mitral valve,and more reliable functional and anatomical assessment of the mitral valve components and its geometry.Suitable surgical intervention can be designed for improving outcomes of patients.

ObjectiveTo assess long-term effect of two different types of arterial reanastomoses for kidney transplantation [an end-to-side anastomoses (ESA) of renal artery to external iliac artery and an endto-end anastomoses (EEA) of renal artery to internal iliac artery] by comparing conventional ultrasound and contrast-enhanced ultrasonography(CEUS) after five years of renal transplantation.MethodsSixty patients underwent kidney transplatation were included and divided into EEA group or ESA group based on the type of anastomoses. Data of renal blood flow perfusion,hemodynamic parameters,and renal anatomical structure were collected and analyzed in each groups using CEUS,color Doppler flow imaging(CDFI) and B-mode ultrasound.ResultsThe patients of the two arterial reanastomoses had no significantly difference in B-mode ultrasound and CDFI. The ESA patients had a slightly better perfusion than the EEA ones in parameters of CEUS.Conclusions Transplant tissue perfusion imaging was performed by CEUS. The perfusion of ESA grafts was slightly better than that of EEA.

Objective To investigate the transfection efficacy and expression of Ang-1 gene and proangiogenesis in vitro and vivo by ultrasound-mediated microbubble destruction.Methods 293T cells were divided into three groups:group A was given hAng-1 plasmid and microbubbles plus ultrasonic irradiation,group B was given hAng-1 plasmid and ultrasound,group C was given hAng-1 plasmid only (without ultrasound).Forty-eight hours after transfection,the transient expression rate was observed under fluorescence microscopy and flow cytometry.RT-PCR and Western blot analysis were taken to evaluate the mRNA and protein expression of Ang-1 respectively.Twenty-seven rabbit models of ligated left circumflex branch coronary artery were divided into 3 groups randomly as follow:group Ⅰ (accepted intravenous injection of SonoVue microbubble and Ang-1 plus ultrasonic irradiation),group Ⅱ (accepted intravenous injection of Ang-1 with ultrasound),group Ⅲ (control group).Myocardial contrast echocardiography (MCE) was executed on all animals before and after the treatment.Two weeks after gene delivery,RT-PCR and Western blot analysis were taken to evaluate mRNA and protein expression of Ang-1 respectively.Microvessel density (MVD) counting of infracted myocardium,observed by Factor Ⅷ immunochemical staining,was performed to value the proangiogenesis effect of Ang-1 delivered by ultrasound mediated cavitation of microbubble.Results Green fluorescence was observed in group A and B by fluorescence microscopy,which was negative in group C.The transfection expression rate was significantly improved in group A ( P ＜ 0.01).In vivo,Microbubbles could be observed in former ischemic myocardium in MCEexamination and the Ang-1 mRNA and protein could be detected in group Ⅰ.On the other hand,the contrast agent was defected obviously and none of the animals showed Ang-1 mRNA and protein expression in other two groups.The MVD counting showed significant improvement in group Ⅰ whereas other two groups didn't.ConclusionsMicrobubble-enhanced ultrasound exposure can improve the Ang-1 gene transfection expression rate observably both in vitro and in vivo.This strategy for delivering has great proangiogenesis effect in vivo.

Objective To access the left internal thoracic artery (LITA) graft late postoperative patency after coronary artery bypass grafting (CABG) by peripheral blood vessel ultrasound combined with color Doppler coronary flow imaging (CDCFI).In contrast with angiography,try to find available flow parameter to access graft patency.MethodsForty-six patients with CABG more than 1 year postoperatively followed-by angiography were detected by ultrasound.The LITA graft and left anterior descending artery were examined.Systolic and diastolic peak velocity(Smax,Dmax),velocity time integral(VTIs,VTId)of each segment were measured separately.The ratio of diastolic and systolic peak velocity (D/S),and diastolic velocity time integral fraction(DVTIF) were calculated.All patients were divided into groups according to angiography results.ResultsThirty -one LITA grafts were patent,11 were dysfunctional,4 were occlusive.According to the angiography results,the flow parameters of the proximal segment of LITA graft were significant.The D/S and DVTIF of patent group was higher than that of dysfunctional group.The diastolic peak velocity of distal segment of LAD of patent group was higher than that of dysfunctional group.ConclusionsPeripheral blood vessel ultrasound combined with CDCFI could provide the evidence to access the patency of the graft.It was an effective method for the clinical follow-up.

ObjectiveTo investigate the haemostatic effect of combining pulsed therapeutic ultrasound (TUS) and microbubble (MB) on splenic trauma.MethodsForteen healthy dogs were divided into 3 groups.Six animals were treated by microbubble-enhanced therapeutic ultrasound (MEUS),the other eight animals were treated with TUS only ( n =4) and the MB only ( n =4) served aS the controls.The spleens of all animals were surgically exposed and a 20 mm long,5 mm deep incision was created on the spleens using scalpel.Human prothrombin complex (HPC) was slowly injected prior to the treatment.During the procedure,the initial bleeding rate and the bleeding rate after the treatment were calculated using gauze weighing.Contrast enhanced ultrasound (CEUS) was performed to assess the blocking effects of splenic circulation.The targeted spleens were harvested for pathological examination.ResultsThere were no differences in initial bleeding rate before treatment.After treatment,in the MEUS group oozed blood was found and the bleeding rate were lower than that of the TUS and the MB groups ( P ＜0.05).A nonenhanced or perfusion defect region was formed within the treated area.The histological results showed splenic sinus hyperemia,platelet aggregation and intravascular thrombosis.Conclusions Microbubbles enhanced pulsed therapeutic ultrasound can arrest the regional blood circulation of spleen by disrupting the microvasculature and this can be used in splenic heamostasis for treating spleen trauma.