Objective To evaluate percutaneous injection of hemostatic agents under the guidance of contrast-enhanced sonography(CEUS) in controlling hemorrhage from severe splenic trauma. Methods Eight patients with splenic traumas of grade Ⅲ, Ⅳ were consecutively enrolled in this study. Percutaneous injection of hemocoagulase atrox and α-cyanoacrylate was performed by CEUS-guidance in all patients. Ultrasound examination was performed at 1,3,7 and 14 days after focal injection. Vital signs and hemoglobin (Hb) level were recorded. Results After the injection,immediate CEUS demonstrated that active bleeding from the injury sites disappeared. From 30 minutes after the injection arterial blood pressure began to ascend ( P <0. 05), and heart rate decreased to the normal level after the treatment ( P <0.05). Hb decreased at first and then gradually increased to the normal level. Conclusions Pereutaneous injection of hemoeoagulase atrox and α-cyanoacrylate under the guidance of CEUS can effectively control bleeding from a severe splenic trauma. CEUS can be helpful to the diagnosis of the suspected splenic trauma and to ensure hemostatic materials to be injected exactly into injury sites.

Objective To study feasibility of combined haemostatic percutaneous injection therapy guided by contrast-enhanced ultrasonography (CEUS) in treatment of renal injuries. Methods Eighteen New Zealand rabbits were inflicted with kidney injury imitating grades Ⅲ-Ⅳ blunt injuries. The animals were randomly and equally divided into three groups, Group A ( treated with hemocoagulase),Group B ( treated with hemocoagulase and Alpha-cyanoacrylate) and Group C ( control group, given normal saline). The hemostatic time, hemostatic effect, and perirenal hematoma were observed. Results A perirenal hematoma was observed one hour after treatment. The perirenal fluid thickness was (0.200 ±0.012) cm in Group A, (0.050 ±0.002) cm in Group B and (0.400 ±0.009) cm in Group C, with statistical significance between two test groups and Group C (P ＜ 0.05 ). At days 7 and 14 following treatment, lesion length and cross section was ( 1. 107 ±0. 143) cm and (0.433 ±0. 163) cm in Group A, (0.567 ±0.082) cm and (0. 160 ±0. 078) cm in Group B, and (0.980 ±0. 203) cm and (0.686 ± 0. 157) cm in Group C. There was statistical significance between the test groups (Groups A and B) and Group C (P＜0. 01) at day 14. The lesion size in Group A was lager than that in Group B (P ＜ 0.01 ). One month after treatment, a slight nephrohydrosis occurred in Group B. Conclusions Either injection of simple hemocoagulase or combined use of hemocoagulase and Alpha-cyanoacrylate guided by CEUS can attain positive hemostatic effect, but the latter one is more rapid and reliable.

Objective To determine whether hemostatic agents directly injected into injury sites under the guidance of contrast-enhanced ultrasound(CEUS)can effectively control hemorrhage from hepatic or splenic trauma. Methods Healthy adult dogs were impacted by a impactor to create hepatic or splenic trauma. Among 32 dogs,28 had hepatic or splenic injury of grade Ⅲ～Ⅳ according to Injury Scale of the American Association for the Surgery of Trauma(AAST),which were divided into two groups,the treatment group and the control. In the treatment group,hemocoagulase and α-cyanoacrylate were injected respectively into the injury site and transected micro-vessel tinder the guidance of CEUS,while in the control group,normal saline was injected. Results All animals of the two groups survived after the injection. CEUS demonstrated that active hemorrhage disappeared in treatment group but still existed in the control group.In the treatment group,laparotomy showed that hepatic or splenic injury had been covered and adhered with clot and glue membrane of hemostatic agents and free intraperitoneal blood volume was significantly less than that in the control group(P=0.000),while in the control group injury bleeding did not stop after injection. Conclusions Hemostatic agents injected under the guidance of CEUS can effectively control hemorrhage from hepatic or splenic trauma of grade Ⅲ～Ⅳ. This therapy was simple,convenient and effective. It may be performed immediately after hepatic or splenic injury was diagnosed.

Objective To explore a method of establishing a canine model of intracerebral hemorrhage (ICH) by puncturing the main branch of middle cerebral artery (MCA) under ultrasonic guidance and proceed a pilot study of contrast-enhanced ultrasound (CEUS) of ICH.Methods Twelve adult healthy mongrel dogs were enrolled in the experiment.In the condition of bone window,the main branch of MCA was punctured to bleed under the ultrasonic guidance.CEUS of brain was performed every 30 minutes until hematoma formed and another CEUS was performed at 24 hours.Then brains were collected for pathologic examination after dogs were euthanized.Results Eleven of twelve dogs developed ICH successfully that located in the Out edge of basal ganglia,which was confirmed by CEUS and autopsy.One dog died within 6 hours due to intraventricular hemorrhage which was confirmed by autopsy.The hematoma diameters were measured as (22.4 ± 7.1)mm by CEUS before euthanasia and as (21.6 ± 6.9)mm on autopsy.There was no significant difference between the two methods of measurement (t =1.521,P =0.1565).The characteristics of active bleeding and hematoma on ICH were performed in the CEUS imaging.Conclusions A model of dog ICH by puncturing the main branch of MCA under the guidance of ultrasound was established successfully,and it proved to be simple,effective and repeatable.The imaging characteristics of this model are in good accordance with those of ICH in patients.

ObjectiveToexplore the appearance ofmusclecrushinjuryatquantitative ultrasonographic elastography by supersonic shear imaging (SSI).MethodsThe animal experiment was done using a special balloon cuff device to create left hind leg crush injury with a force of 18.6 kPa.Twentythree New Zealand rabbits had crush injury of extremity and survived for 72 hours.SSI quantitative elastography was performed in crushed and no-crushed regions of each rabbit hind leg.Quantitative lesion elasticity was measured in terms of the Young modulus (in kilopascals) at 30 min,2 h,6 h,24 h and 72 h after the release of the crushing pressure.A receiver operating characteristic (ROC) curve analysis was used to assess diagnostic performance.ResultsThe area of crushed region in left hind leg accounted for 2.6％ -3.0％ of body surface area in 23 rabbits.The crushed regions exhibited maximum elasticity values of (19.51 ± 6.74)kPa,(21.47 ± 5.54) Pa,(11.36 ± 5.35)kPa,(15.09 ± 3.31)kPa and (13.72 ± 3.74) kPa,and mean elasticity values of (12.44 ± 3.77)kPa,(13.20 ± 3.60)kPa,(6.80±2.86)kPa,(10.04 ± 2.95)kPa and (6.94 ± 0.97)kPa at 30 min,2 h,6 h,24 h and 72 h after the release of the crushing pressure.Comparing with those of no-crushed regions,they were higher obviously (P＜0.001).ROC curves showed that extremity crush injury was diagnosed by using elasticity value,and the greater the elasticity value,the greater the diagnostic value.Conclusions SSI provides quantitative elasticity measurements,thus adding complementary information that potentially could help in crush injury characterization with conventional ultrasonography.

Objective To analyse the cost-effectiveness analysis of the focal injection treatment under the guidance of contrast enhanced ultrasound(CEUS) for the severe abdominal parenchymal organs trauma.Methods One hundred and twelve patients with severe abdominal parenchymal organs trauma,including 42 hepatic injuries,52 splenic injuries and 33 renal injuries,were rolled in this study. The cost-effectiveness of this group was compared with that of surgery group. Results Treatment duration of single organ trauma under the guidance of CEUS was 20 - 30 minutes. During the first 72 hours after the focal injection, blood pressure and heart rate were improved ( P ＜0.05). Free intraperitoneal liquid did not increase on immediate US image of post-therapy and then it disappeared gradually. Heart rate returned to normal level after injection treatment ( P ＜0. 001 ). Lengths of stay in hospital was 3 - 11 (5.4 ± 2.4)days, which was not different with 3 - 9(5.1± 1.9) of surgery group( P ＞0.05). Treatment cost was 0.32 - 0.43 (0.36 ±0. 14) ten thousand RMB, which was obviously less than 3. 1 - 4. 2 (3.6 ± 10.8) ten thousand RMB of surgery group ( P ＜ 0.01 ). Conclusions The efficacy of the focal injection treatment of the severe abdominal parenchymal organs trauma under the guidance of CEUS was consistent with that of the operative treatment, but its cost was less. Especially it benefited for reserving organs and less pain.

Objective To approach the diagnostic value of contrast-enhanced ultrasonography(CEUS)for the detection of traumatic laceration of pancreas. Methods Sixty cases of pancreatic traumatic model were made in twelve healthy swines after the animals were anesthetized and laparotomized. Then the conventional ultrasonography(US) and CEUS were performed in each case to diagnose the traumatic region,immediately. The results were compared with surgical findings. Results Among sixty injuries,the detection rate of conventional ultrasonography was 66. 7%,the detection rate of CEUS was 88.3%. Conclusions CEUS shows higher detection rate than conventional US in diagnosing pancreatic laceration,and it also can improve the diagnostic value of ultrasound for the detection of pancreatic laceration.

Objective To explore the value of percutaneous injection of hemostatic agents under the guidance of contrast-enhanced ultrasound(CEUS)for grade Ⅲ-Ⅳ hepatic trauma patients.Methods Eleven patients with severe hepatic trauma were treated using percutaneous focal injection of hemostatic agents.Five of these patients were hepatic injury of grade Ⅲ,and others were grade Ⅳ according to AAST.Results Out of all patients with severe hepatic trauma,9 patients were cured by once percutaneous injection of hemostatic agents under the guidance of CEUS,and 1 patient was cured by twice injection,and 1 patient was switched to surgery because of complicated pancreatic injury and the increase of free intraperitoneal fluid.Conclusions CEUS can display the site and severity of liver injury.Combining with interventional technology,injection of hemostatic agents under the guidance of CEUS can save life and avoid to resect organ,and it can win time for treating other compound injury.

Objective To compare the value of contrast-enhanced ultrasonography (CEUS) with that of laparoscopic ultrasonography (LUS) in localization diagnosis of insulinoma. Methods Thirty-three patients with insulinoma,who received operation, were retrospectively reviewed. All cases were examined by both CEUS and LUS before the tumor removed. Both imaging modalities in diagnosis of insulinoma were analyzed. Results By this study the sensitivity and accuracy of CEUS were 92.31% and 90.0% respectively. Those of LUS were consistent with pathologic findings completely. The accuracy of CEUS was not different with that of LUS (χ2 = 4.21, P = 0. 04). Conclusions CEUS can be used for location diagnosis of insulinoma. For the patients expecting laparoscopic treatment, combination of CEUS with LUS will be suggested before insulinoma is removed.

Objective To study haemostatic percutaneous injection therapy for the management of vascular damage in patients with renal injuries guided by contrast-enhanced ultrasonography(CEUS).Methods Which of 56 patients with renal trauma were diagnosis by CEUS,37 cases with grades Ⅱ-Ⅳ renal injuries were brought into our study.According to wound degree and accompanying active bleeding,they were divided into experiment group (percutaneous injection hemostatic treatment)and control group(conservative treatment).Results Thirty-seven renal trauma manifest low perfusion in lesions by CEUS,and the contrast agent could be seen overflow to renal pelvi and the location of capsule in 13 patients.The patients were divided into experiment group(17 cases)and control group(20 cases).The color of hematuria of 9 patients in experiment group became gradually light at 30 mins after treatment.and the color of 7 cases become normal,and hematuria of the only one was iterative appear.The color of hematuria of 9 patients in control group became gradually light in 24-72 hours,others' hematuria became gradually light in 5-14 days.The time of color of hematuria become light of the former was shorter than those of the latter(P<0.05).Reexamination by ultrasound and renal function and urine routine at 1,3 and 6 months after treatment,the results of all patients indicated normal.Conclusions Haemostatic percutaneous injection therapy for renal trauma guided by contrast-enhanced ultrasonography has very obvious hemostatic efficacy.Its advantages included may be used for effective,minimally invasive control of renal injuries(grades Ⅱ-Ⅳ),and can be a feasible management of active bleeding at bedside.