1.0 cm in diameter.

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 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 assess the characterization and usefulness of contrast enhanced ultrasound (CEUS)to diagnose solid focal lesions of pancreas(s-FLPs)in comparison to contrast enhanced computed tomography(CECT).Methods Forty-nine s-FLPs with final diagnosis were studied with low mechanical index CEUS and CECT.The enhanced patterns and diagnostic capability of CEUS were analyzed,and these results were compared with those from CECT.Results ①In CEUS,the perfusion of capillary could be detected in vascular phase.②The concordance of dual-phases enhanced patterns between CEUS and CECT was 73.5%(36/49).The concordance of enhanced level between early parenchymatous perfusion phase in CEUS and pancreatic phase in CECT could achieve 87.8%(43/49).Hypo/hypo enhancement was the most common enhanced pattern of pancreatic carcinoma in CEUS and CECT.③There was no statistical significance between CEUS and CECT in the differential diagnostic.Conclusions The concordance of enhanted patterns between CEUS and CECT is satisfactory.CEUS is similar to CECT in the differential diagnosis of s-FLPs.CEUS would become an important non-invasive diagnostic method for s-FLPs.

Objective To investigate the value of intra-cavitary contrast enhanced ultrasound(CEUS)in the location of drainage tubes which were unclear in conventional ultrasonography. Methods The locations of 32 drainage tubes in 26 patients were unclear in conventional ultrasonography. The diluted ultrasound contrast agent (SonoVue) was injected through the tubes. CEUS was used to evaluate the visualizations of the inner tubular portions and the distal ends. Whether the drainage tubes were in situ or not was also judged. The time-consumption of detection was counted. Results The percentages of the visualization of inner tubular portions and the distal ends in conventional ultrasonography were 52.25%(18/32) and 0,respectively. However,the percentages of visualization in CEUS were 100% and 93.75%(30/32), respectively. The difference were significant when compared conventional ultrasonography with CEUS ( P＜0.001 ). CEUS detected that three drainage tubes weren't in situ. And the median of timeconsumption of CEUS was just 4. 5 seconds (range: 1-77 seconds). Conclusions Intra-cavitary CEUS is a sensitive and high efficient technique in the visualization of drainage tube which may complement the insufficiency of conventional ultrasonography. It could be used as the first choice in the location of drainage tube.

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.

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.

Objective To discuss the use of contrast enhanced intraoperative uhrasound(CE-IOUS) in evaluating hepatic radiofrequency ablation(RFA)lesions.Methods Fifteen RFA lesions in twelve dogs were examined by IOUS and CE-IOUS 15 min and 30 min after RFA.IOUS and CE-IOUS images were compared with RFA specimen stained by TTC.Results Satisfactory images could be achieved bv CE-IOUS at 15 rain after RFA.Compared with IOUS,CE IOUS could depict the border of RFA lesions more clearly (P＜0.01).In CE-IOUS,93.3%(12/13)of RFA lesion images were consistent with that of TTC in shape,while in IOUS,only 13.3%(2/15)of the images were consistent with that of TTC in shape.The average areas of RFA lesions cross-section measured by IOUS,CE-IOUS and TTC were(4.82±1.49)cm2,(3.48±1.25)cm2 and(2.93±0.87)cm2.Statistical significance was found between the areas shown by IOUS and TTC staining(P=0.000),as well as between CE-IOUS and TTC staining(P=0.027).The areas shown by IOUS and TTC were not linear correlated(r=0.28,P=0.316),but the areas shown bv CE IOUS and TTC were wetl correlated(r=0.75,P=0.002). Conclusions CE-IOUS is a promising method for evaluating intraoperative RFA lesions and worthy of further clinical research.

Objective To assess the difference between two-dimensional contrast-enhanced ultrasonography ( 2D-CEUS ) and three-dimensional contrast-enhanced ultrasonography ( 3D-CEUS ) in evaluating hepatic arteries in the liver transplantation. Methods Both 2D-CEUS and 3D-CEUS were used to examine 26 liver transplantation donors and recipients. Fifteen patients who were confirmed by CTA or DSA or MRA were analyzed. The image' s quality and diagnostic levels of 2D-CEUS and 3D-CEUS were compared, and the diagnostic information about anatomic features of hepatic arteries provided by the two methods was evaluated. Results 1) The image' s quality of 2D-CEUS and 3D-CEUS were 3. 62 ± 0. 41, 2. 52 ± 0. 93, respectively. The difference between them was statistically significant ( P <0. 05). 2)When evaluating anatomic features ,2D-CEUS and 3D-CEUS had no significant difference in common hepatic artery (CHA) and proper hepatic artery (PHA). But 3D-CEUS was prior to 2D-CEUS in left hepatic artery (LHA) ,right hepatic artery(RHA) and segmental hepatic artery(SHA) ( P <0. 05). 3)Five hepatic artery complications were discovered by CTA or DSA or MRA in 15 patients. In 4 patients (80%) ,both 2D-CEUS and 3D-CEUS made the affirmative diagnoses in accordance with the results. However, 2D-CEUS made a false positive diagnosis and 3D-CEUS corrected it. Conclusions The 3D-CEUS could provide more diagnostic information,could confirm or correct some diagnosis of 2D-CEUS,but,its image's quality is not as good as 2D-CEUS. Therefore,combining the 3D-CEUS with 2D-CEUS has practical clinical value in liver transplantation.