Objective To explore the value of real time contrast-enhanced ultrasound (CEUS) in differential diagnosis of benign and malignant adrenal lesions.Methods Totally,57 adrenal lesions (26malignant and 31 benign) underwent conventional ultrasound and real-time CEUS.The enhancement patterns including types of time-intensity curve,centripetal fill-in,homogeneity and intensity of enhancement were analyzed.Results The enhancement pattern of normal adrenal gland was homogeneous,centrifugal and rapid perfusion from the medulla to the cortex.Four enhancement patterns were significantly different between benign and malignant adrenal lesions (P ＜0.05).If enhancement in the early arterial phase and rapid washout was suggestive of malignancy,the sensitivity and specificity of CEUS were 96.2％ and 77.4％,respectively.If peripheral to central filling was suggestive of malignancy,the sensitivity and specificity of CEUS were 76.9 ％ and 80.7 ％,respectively.Conclusions The patterns of real-time CEUS are helpful in differential diagnosis of malignant and benign adrenal lesions.

Objective To evaluate the effects of isoflurane anesthesia on NR1 expression and neuronal apoptosis in the hippocampus and cortex of adult rats .Methods Thirty-six adult male Sprague-Dawley rats , weighing 250-280 g ,were randomly assigned into 3 groups using a random number table :control group (group C , n=6 ) ,O2 inhalation group (group O , n=6 ) and isoflurane anesthesia group (group I , n=24 ) .The rats were exposed to 2% isoflurane (group I) ,to pure oxygen (group O) ,or to air (group C) for 2 h .At 2 h ,and 1 ,7 and 14 days after the rats were awake (T1-4 ) ,Morris water maze test was performed .The rats were then sacrificed and brains were removed for isolation of the hippocampus and cortex .NR1 expression was detected using SABC immuno-histochemical technique and neuronal apoptosis was determined using TUNEL .Results Compared with group C , the escape latency at T2 and total swimming distance at T1 ,2 were significantly prolonged , and the expression of NR1 in hippocampi was down-regulated at T1 ,2 in group I ,and the expression of NR1 in the cortex was down-regulated in O and I groups ( P<0.05) .There was no significant difference in the apoptosis index between the three groups ( P> 0.05 ) .Conclusion Isoflurane anesthesia can decrease the cognitive function transiently ,which is related to inhibition of up-regulation of NR1 expression in the hippocampi ,but not related to neuronal apoptosis in adult rats .

Objective To analyze the difference of irradiation dose and volume of organs at risk (OAR) particularly in small intestine between supine position and prone position on intensity-roodulated radiotherapy(IMRT) for cervical cancer. Methods 11 patients with Ⅱ_B-Ⅲ_B cervical cancer were scanned with supine position and prone position by CT.The CT images were transported to TPS,then target volumes were delineated and the IMRT plans were designed respectively.The prescribed dose was 95%PTV receiving 45 Gy in 23 fractions of 2 Gy.The exposure volumes of the OAR at different position and different dose levels in the dose volume histograms (DVH) were compared and analyzed.Results When tlle dose di8tributions met to the clinic request,the exposure volumes of small intestine at prone position were redueed than that at supine position in dose range 46-30 Gy(P<0.05),but this phenomenon Was not distinct in low dose range(< 20 Gy)(P>0.05).The exposure volumes of bladder, rectum, femur head and spine cord were no obviously differences at dissimilar position. Conclusion IMRT of cervical cancer should adopt prone position.because their small intestine will be protected better.

Objectives:To investigate the clinical significance of the expression level of cytokeratin5/6/18 positive cells in peripheral blood cells from patients with breast carcinoma.Methods:The expression rates of ck5/6/18 positive cells in peripheral blood cells from 56 patients with breast carcinoma were measured and analyzed by flow cytometry.Results:The expression rates of ck5/6/18 positive cells in peripheral blood cells from 56 patients with breast carcinoma was 46.4% and there was significant differences compared with healthy volunteers and the patients with breast benign diseases.The positive rates increased significantly with the pathological staging and show no significant relationship with the ER and PR.Conclusion:The expression of ck5/6/18 positive cells in peripheral blood cells correlates significantly with the pathological staging of breast carcinoma and it could be an effective signal to clinical monitor and prognosis.

AIM To establish the hyperlipidemia and hyperlipidemic fatty liver animal model.METHODS 30 SD rats were randomized into control group (n=10)and model group(n=20).The rats of model group were fed with a standard diet and fat emulsion( 10 ml?kg -1);while the rats of control group were only fed with a standard diet.The serum TG,TC,ALT,AST,MDA,SOD and hepatic TG,TC,MDA,SOD were detected dynamically and with histologically.RESULTS The model group developed hyperlipidemia which TG and TC were elevated significantly after 1 week. 10 rats which were selected randomly in the model group were killed and the serum and liver were obtained after 2 weeks. The serum TG,TC,ALT and hepatic MDA of the model group rats were higher than the control's,while the hepatic SOD were lower. At the same time,the light degree hepatic steatosis of 2 rats were induced.The third week,both control group and model rats(n=10) were killed and the serum and the liver were obtained. Compared with the control group, the serum TG,TC,ALT,AST,MDA?SOD and hepatic TG,MDA of the model group rats were markedly higher, while the serum SOD and the hepatic SOD were significantly lower.The histopathology research showed hepatocellular macrovesicular steatosis and hepatitis in the model group. CONCLUSINOS The experimental animal model of hyperlipidemia and hyperlipidemic fatty liver in rats were successfully established for 1 week and 3 weeks fed with fat emulsion.

Objective To study the imaging characteristics of intracranial dysembryoplastic neuroepithelial tumors(DNT),and to evaluate the role of CT and MRI in their diagnosis.Methods We presented 8 DNTs cases confirmed histopathologically after operation.CT and MRI features were retrospectively analyzed(3 cases received MR scan only and 5 had both studies),compared with the surgical findings and pathological appearance.Results Eight patients had totally 11 tumors with multifoci in 2 cases.Six DNTs were located in the temporal lobe,1 lesion involved the parietal lobe,1 in the frontal lobe,1 in the brain stem,1 in the cerebellum,and 1 in the frontal and temporal lobe simultaneously.All lesions were observed intracortically,and partial of them extended into the subcortical location.On 5 non-contrast CT scans,3 DNTs were homogeneously hypodense;1 case contained isodense nodules within the hypodense focus.Peripheral spotty calcification was found in 1 case.On pre-contrast MR images,all lesions showed hypointense on T_1-weighted images,moreover,multicystic change with more markedly decreased signal intensity was observed.The DNT had a well-demarcated,multinodular gyriform configuration,or a soap bubble appearance at the cortical margin.On T_2-weighted images,high signal intensity of the tumors was seen except for hypointense calcification.The bone remodeling of the adjacent calvaria was noticed in(1 case.) The tumors had slightly increased signal intensity on FLAIR(fluid attenuated inversion recovery) in 2 cases,and homogeneously mild hyperintense on PDW(proton density weighted imaging),while the isointense focus was observed in one case on DWI(diffusion weighted imaging).No obvious enhancement was identified except 1 lesion with mild enhancement following intravenous administration of contrast material.3 tumors had ill-defined contours,whereas the others showed well-demarcated margins.No surrounding vasogenic edema was present except 2 foci with slight edema.Conclusion DNT usually shows characteristic radiologic findings,in combination with the clinical presentation and history,the diagnostic accuracy should be improved,and,as such,unnecessary radiation and/or chemotherapy may be avoided.

Objective To evaluate the value of contrast-enhanced ultrasound and ultrasonic elastography in the diagnosis of breast lesions with BI -RADS Ⅲ -Ⅴ.Methods 169 patients with BI -RADS Ⅲ -Ⅴ breast lesions were underwent contrast -enhanced ultrasound and ultrasonic elastography 1 week before surgery.Pathological findings were used as the gold standard to evaluate the diagnostic accuracy of contrast -enhanced ultrasound and ultrasonic elastography in diagnosis of BI -RADS Ⅲ -Ⅴ breast lesions.Results The combination of contrast -enhanced ultrasound and ultrasonic elastography in diagnosis of BI -RADS Ⅲ -Ⅴ breast lesions,with the sensitivi-ty,specificity and accuracy of 96.15%,94.34%,and 95.11%,respectively.The difference was statistical signifi-cance compared with single method(χ2 =4.659,P =0.032,χ2 =4.146,P =0.041).Conclusion The combination of contrast -enhanced ultrasound and ultrasonic elastography improves the diagnostic accuracy of Ⅲ-Ⅴ breast lesions.

Objective To evaluate the diagnostic value of shear wave elastography(SWE)and Breast Ima-ging Reporting and Data System -Ultrasonograpy(BI -RADS -US)in benign and malignant breast lesions.Methods 180 patients with pathological -confirmed benign and malignant breast lesions without any treatment were underwent ultrasonography scoring with BI -RADS and the quantitative elasticity parameters was measured by shear wave elastography 1week before operation.Pathological results were regarded as the gold standard,receiver operating characteristic curve(ROC)was used to determine cutoff values of quantitative parameters and diagnostic performance of two methods.Results Maximum elastic value(Emax)and mean elastic value(Emean)of benign breast lesions were (39.17 ±11.48)kPa and (21.56 ±9.68)kPa,which were significantly lower compared with the malignant breast lesions of (121.38 ±28.97)kPa and (62.92 ±18.49)kPa,respectively(t =23.668,P =0.000;t =18.194, P =0.000).Taking 43.79kPa and 65.15 kPa as the threshold of the Emean and Emax value,the sensitivity,specificity and accuracy of SWE were 92.59%,90.78% and 94.84%,respectively.The areas under the curve(AUC)of the SWE and BI -RADS -US were 0.942 and 0.883 (P =0.042).Conclusion SWE can improve the accuracy of ultrasonography in differentiation of benign from malignant breast lesions by quantitative elasticity parameters,which has important significance for clinical treatment.

Objective To explore oral contrast-enhanced ultrasonography findings in superior mesenteric artery syndrome (SMAS).Methods Twenty-nine patients with SMAS were examined using oral contrast-enhanced ultrasonography,which was confirmed by contrast-enhanced spiral computerized tomography.Results Abdominal ultrasonography with oral contrast-enhanced ultrasonography revealed a significant reduction of the SMA angle and diminished SMA-aorta distance in 29 subjects.Duodenum was showed the indentation and funnel shaped or dumbbell shaped findings which was caused by pressure of the SMA in patients with recumbent position.The proximal part of duodenum expanded distinctively with contrast media movement fro.Ultrasonography and CT examinations had a good agreement in diagnosing pathological aortomesenteric angle and distance.Conclusions Oral contrast-enhanced ultrasonography presents characteristic findings in patients with SMAS,which is useful in epidemiological screening of suspicious cases of SMAS in children.

Objective To study the spatial distribution of set-up errors for cervical cancer with intensity modulated radiation therapy (IMRT) and to provide referential safety margin out of clinical tumor volume (CTV) during treatment plan design. Methods Six patients with cervical cancer were treated with IMRT in prone position, belly board and thermoplastic cast was used for immobilization. Measurement were made on a daily basis setup under five consecutive treatments with electron portal images device (EPID).Portal films from two projection (one anter-posterior and one opposite lateral)were taken. Sixty portal films were analyzed. The translational and rotational deviations were analyzed by registering and comparing the bony structures of EPID and digitally reconstructed radiographs (DRR). Results The translational deviations were (3.1 ±1.8) mm, (3.9 ±3.3) mm, (4.2 ±2.6) mm in medi-lateral, cranio-caudal and anterior-posterior directions, the rotational deviations were in coronal plane (0.8±0.9)° and sagittal plane (1.2±1)°. Conclusion For the patients with cervical cancer undergoing IMRT, the margins between the CTV and PTV should be 7.1 mm in lateral direction, 10.4 mm in cranio-caudal and 10.8 mm in anterior-posterior directions. The sign on patients body can help to reduce the setup errors.