Objective To observe the ultrasonographic features of intravenous leiomyomatosis (IVL). Methods Ultrasonographic features, pathological results and the clinical manifestations of 7 patients with IVLs were analyzed retrospectively, and the causes of misdiagnosis were discussed as well. Results The median age of 7 IVL patients was 40 years old. Five patients underwent previously hysterectomy due to probable diagnosis of leiomyoma with the mean recurrent time of 13.8 months. Three lesions extended into the right atrium, 3 involved the inferior venous cava and 1 was confined in the pelvis venous. Ultrasonographic findings of IVL included uterine solid lesions with intravascular disease, solid occupied lesions in the pelvis with intravascular disease after hysterectomy, solid occupied lesions in the pelvis, large abdominal vessels and cardiac chambes with intravascular disease after hysterectomy. The main misdiagnosis cause was that IVL had similar ultrasonographic features with hysteromyoma, and intravascular lesions of IVL was hard to detect in the early stage. Conclusion Color Doppler ultrasonography is a valuable imaging mortality for detection and follow-up of IVL.

Objective To assess the value of endorectal elastography in the diagnosis of malignant rectal adenoma. Methods Sixty patients referred to the department of basic surgery of Peking Union Medical College Hospital for the evaluation of rectal adenoma from January 2011 to May 2013 were included in this prospective cohort. All patients underwent elasticity score (ES) and strain ratio(SR) examine before operation. To evaluate the reproducibility of the strain-ratio measurements, the intraclass correlation coefficient (ICC) was calculated. Compared with final operational pathological results,the diagnostic values of elasticity score and strain ratio method were assessed. Results Histopathological result showed there were 20 adenomas and 40 adenocarcinomas. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ERUS was 68%(27/40), 40%(8/20), 58%(35/60), 69%(27/39), 38%(8/21), respectively. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of elasticity score was 85%(34/40), 70%(14/20), 80%(48/60), 85%(34/40), 70%(14/20), respectively. The SR of adenocarcinomas was significantly higher than that of adenomas(2.82±1.81 vs 1.23±0.57, t=3.333, P < 0.05). The differences among the SR of benign adenoma, benign adenoma with severe atypical hyperplasia and completely malignant lesions were statistically significant (1.26±0.84 vs 2.94±1.95, 1.42±0.55 vs 2.94±1.95, t=2.619, 2.415, P=0.013, 0.021). When 1.240 was chosen as the best cut-off value of SR, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of strain ratio was 82%(33/40), 75%(15/20), 80%(48/60), 87%(33/38), 68%(15/22), respectively. Conclusion Endorectal elasotgraphy can accurately diagnose the malignant rectal adenoma, which can provide reliable preoperative imaging evidence for clinical operation mode.

OBJECTIVE: To determine whether Schwann cells (SCs) and fibronectin (FN) support the growth of damaged axons and their conductive function. METHODS: Thirty adult Sprague-Dawley (SD) rats were randomized into 3 groups (n=10), and the following grafts: both SCs and FN, FN, and basal medium were implanted respectively into the lumbar of spinal cords hemisected at vertebra T(12). RESULTS: At 6 weeks postoperation, the latencies of spinal cord evoked potential (SCEP) P(1) wave in the three groups were 1.57 ms, 1.84 ms, and 2.03 ms, respectively. The differences between SCs/FN group and the other two groups were statistically significant. The number of regenerated axons in SCs/FN group was significantly greater than that in FN group. The number of survival neurons in L(4) and L(5) left dorsal root ganglia (DRG) in SCs/FN group was significantly greater than that in the rest two groups respectively. The latencies of P(1) wave were significantly correlated with axon counts in both SCs/FN and FN groups. CONCLUSIONS: SCs/FN grafted to the hemisected lumbar of spinal cords can produce robust axon regeneration and promote partial repair of their conduction. Surface recording of SCEP technique has been proved to be a reliable and less-traumatic method for assessment of recovery of afferent conduction in hemisected spinal cord.

Objective To evaluate and screen out the specific characters of thyroid nodules on grayscale and color Doppler ultrasonography. Methods One hundred and four thyroid nodules in 95 patients were studied with gray-scale and color Doppler ultrasound before surgery.According to the probability of malignancy,the main independent characters were screened out by Logistic regression analysis and then got the formula which could calculate the probability of malignancy.Results Fifty three nodules,included 44 hyperplasia,7 adenomas,1 switch granuloma and 1 Hashimoto's disease,were benign.Fifty one nodules,included 47 papillary carcinomas,3 medullary carcinomas,1 metastatic carcinomas,were malignant pathologically.The significant characters to differentiate malignant from benign were the shape,margin,border,halo,echostucture,echogenecity,echo uniformity,calcicum,bolood vessel shape and partial abnormal rich blood of thyroid nodules.After two variables logistic regression analysis,a fomula were worked out.Probability of malignancy=1/1+e-z,which z=-7.44+1.30×halo+1.05×calcicum+1.5×vessel shape.If a thyroid nodule with no halo,microcalcicum and irregular vessel shape,the probability of malignancy was 0.99,while with complete halo,no calcicum and regular vessele shape,the probability of malignancy of the nodule was 0.02.Conclusions The halo,calcium and blood vessel shape of thyroid nodules were three independent characters of thyroid nodules to predict malignant thyroid nodules on gray scale and color Doppler ultrasound.

Objective To evaluate the diagnostic value of sonographic score in the diagnosis of salivary gland involvement in patients with Sj(o)gren's syndrome(SS). Methods One hundred and three cases (44 cases of SS group and 59 cases of control group) were involved in the study. Parotid and submandibular glands of all the cases were examined by a doctor unawaring of the clinical information. All the off-line images were scored by two doctors seperately. The best threshold and the according diagnostic efficiency were determined by statistical analysis. Results The Kappa coefficient between the two doctors was 0.80.The parotid score,submandibular score and total score of SS group were significantly higher than those of the control group (5.79 ± 2.40 vs 0.46 ± 0.97,5.93 ± 1.58 vs 1.32 ± 1.84,11.64 ± 3.27 vs 1.78 ± 2.33,respectively). According to the ROC curve for the parotid score, submandibular score and total score, the area under the curve were 0.98,0.95,0.99, respectively. The best diagnostic threshold for total score was 8 and under this threshold, the diagnostic sensitivity, specificity, positive and negative predictive values were 93%, 97%, 95%, 95%, respectively. Conclusions The sonographic score including both parotid and submandibular glands is a reliable method with high reproductivity and diagnostic accuracy in the diagnosis of SS salivary gland involvement.

Objective To investigate the ultrasonographic manifestation of renal oncocytoma. Methods The sonographic appearances of 12 patients with pathologically confirmed RO were retrospectively reviewed, and the size, margin, configuration, echogenicity and blood flow distribution of the lesions were analyzed. Results All of the 12 RO were detected and located correctly, among which 3 cases were misdiagnosed as renal cell carcinoma and 9 cases were not qualitatively diagnosed with ultrasound. The lesions manifested as central stellate scar in 8.33%, homogeneous enchogenicity in 66.67%, well-defined in 75.00%, regular-shape in 91.67% and isoechoic in 58.33%. Among these lesions, 6 (50.00%) were hypervascular with spoke-wheel distribution, 5 (41.67%) were hypovascular, and 1 (8.33%) was avascular, while peripheral blood flow were seen in 7 lesions (66.67%). Conclusion The diagnostic ability of ultrasound for RO is limited, but a homogeneous, well-defined solid lesion with spoke-wheel distribution of blood flow, especially with a stellate scar may suggest RO.

Objective To evaluate the differences among five representative and useful Doppler parameters in the diagnosis of the three common types of renal artery stenosis (RAS). Methods Five Doppler parameters including renal peak systolic velocity (RPSV), renal-aortic ratio (RAR), renal-interlobar ratio (RIR),acceleration time (AT),and resistant index (RI) were measured in 221 patients before renal arteriography. Differences between the groups of patients with various clinical causes of RAS were analyzed by Chi-Squared test. One-way ANOVA or t test were used to compare the means between different groups.The optimal cutoff value was determined with the maximum sum of sensitivity and specificity. Results Of the 442 renal arteries (main and accessory renal arteries) demonstrated at arteriography,214 were normal or stenosed less than 50 %, 204 stenoses 50% - 99 %, and 24 occlusions. RIR, RAR and RI were significantly different between the atherosclerotic and non-atherosclerotic RAS groups (P ＜0.05), while RPSV and AT were not. The optimal cutoff values of RAR,RIR and RI for detecting RAS between the atherosclerotic and non-atherosclerotic groups were much different (2.5 versus 1.9, 5. 1 versus 6.5, 0.57 versus 0.50,respectively) ,but those of RPSV and AT were similar or the same (170 cm/s versus 200 cm/s,51 ms versus 51 ms,respectively). Conclusions In the case of RAS (diameter reduction≥50%),it is advised to establish separate cutoff values of RAR, RIR and RI according to atherosclerotic and non-atherosclerotic RAS, but the same cutoff value of RPSV and AT can be applied. RIR is a good Doppler parameter in the diagnosis of RAS,especially atherosclerotic and fibromuscular dysplasia RAS.

OBJECTIVETo study the sonographic features and patterns of cystic renal carcinomas.

METHODSThirteen cases of cystic renal carcinoma confirmed by operation and pathology were examined by ultrasonography, and the cystic walls, septa and solid mural nodules were studied.

RESULTSSolid mural nodules of some cases and irregular thickening of the cystic walls and septa were characteristic findings for the ultrasonic diagnosis of cystic renal carcinomas. According to their pathologic mechanisms and sonographic features, cystic renal carcinomas were classified into 3 patterns: unilocular cystic mass, multiloculated cystic mass and cystic-solid mass.

CONCLUSIONSTypical cystic renal carcinomas can be well diagnosed, while atypical cases may be misdiagnosed as benign renal cysts by ultrasonography. Color Doppler ultrasonography and needle aspiration guided by ultrasonography are helpful in the diagnosis of these atypical cases.

Adult ; Aged ; Biopsy, Needle ; Carcinoma, Renal Cell ; diagnostic imaging ; Diagnosis, Differential ; Female ; Humans ; Kidney Diseases, Cystic ; diagnostic imaging ; Kidney Neoplasms ; diagnostic imaging ; Male ; Middle Aged ; Ultrasonography, Doppler, Color

OBJECTIVETo evaluate the accuracy of endorectal ultrasound (ERUS) in predicting the circumferential resection margin (CRM) and maximum tumor thickness (MTT) of in T3 rectal cancer.

METHODSClinicl data of 53 patients with pT3 rectal cancer admitted to the Department of General Surgery in the Peking Union Medical College Hospital from June 2011 to January 2014 were retrospectively analyzed. CRM and MTT measured by ERUS were compared with corresponding pathologic measurements to assess the accuracy of ERUS diagnosis.

RESULTSERUS correctly predicted CRM status in 52 patients (98.1%, 52/53), whose sensitivity was 100%, specificity was 97.8%, positive predictive value was 85.7%, and negative predictive value was 100%. ERUS correctly predicted MTT status in 51 patients (96.2%, 51/53), whose sensitivity was 100%, specificity was 95.5%, positive predictive value was 66.6%, and negative predictive value was 100%. In the Bland and Altman plot, the agreement between ERUS and pathology was good.

CONCLUSIONEndorectal ultrasonography can accurately diagnose CRM and MTT, which can satisfy the clinical need for preoperative staging of rectal cancer.

Colectomy ; Humans ; Neoplasm Staging ; Peritoneum ; Rectal Neoplasms ; ultrastructure ; Retrospective Studies

Objective To compare the application of ultrasound and positron emission tomography/computed tomography (PET/CT) in diagnosis and lymph node staging of breast cancer. Methods Using automated breast volume scanner (ABVS) and PET/CT examination of 40 lesions in 38 patients, and for comparison with the pathological findings, the diagnostic accuracy of PET/CT and ABVS in breast cancer was comparatively analyzed. Results The sensitivity of ABVS in the diagnosis of breast cancer was 95.65%, the specificity was 70.59%, and the accuracy rate was 85.00%; the sensitivity of PET/CT in the diagnosis of breast cancer was 86.96%, the specificity was 82.35%, and the accuracy rate was 85.00%;the diagnostic sensitivity of their combined application was 86.96%, the specificity was 94.12%, and the accuracy rate was 90.00%. In 10 cases of breast cancer patients with lymph node metastasis, the sensitivity、specificity and accuracy rate of PET/CT in the diagnosis of metastatic lymph nodes were 90.0%, 92.8%, and 92.1% respectively; the sensitivity, specificity and accuracy rate of ultrasound in the diagnosis of metastatic lymph nodes were 70.0%, 96.4% and 89.5%, respectively. Conclusions The ABVS and PET/CT are both effective approaches in the diagnosis of breast cancer. Their combined application may significantly improve the specificity and accuracy of diagnosis. For patients with lymph node metastases, the sensitivity of PET/CT for lymph node metastases was high and conducive to clinical staging, which is an important implication in guiding the choice of clinical treatment and prognosis of patients.