Objective To investigate the clinical value of double contrast-enhanced ultrasonography (DCEUS) in assessing the peripancreatic vascular invasion of pancreatic carcinoma.Methods Twenty-eight patients with pancreatic cancer confirmed by postoperative pathology were examined by DCEUS preoperatively.The relationship between neoplasms and peripancreatic vessels was analyzed for assessing whether vascular invasion of pancreatic cancer had occurred.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of DCEUS in evaluating vascular involvement were calculated by using the surgical results as a gold standard.Kappa test was used for assessing the intra- and interobserver reliability of DCEUS.Results In total 28 patients,21 cases were diagnosed as vascular invasion,whereas,7 cases were noninvasive by surgical results.By DCEUS,18 cases were assessed as positive involvement of vessels,whereas,10 cases were negative.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of DCEUS in evaluating vascular involvement were 85.71 ％,100％,100 ％,70.00 ％ and 89.29 ％ respectively,and with higher reliability (Kappainter =0.75,Kappa =0.80).Conclusions DCEUS could be considered as a novel method to assess vascular invasion of pancreatic carcinoma accurately and reliably.

Objective To investigate the clinical value of double contrast-enhanced ultrasonography (DCUS) in diagnosing lymph nodes metastasis of gastric carcinoma.Methods One hundred and sixteen patients with gastric cancer diagnosed by gastroscope and confirmed by pathology after operation were examined by DCUS preoperatively.The enhanced characteristic of gastric carcinoma tissues was assessed by autotracking contrast quantification(ACQ) software.The baseline intensity(BI), peak intensity(PI), arrival time(AT) and time to peak(TTP) of gastric cancer was measured automatically,and the enhanced intensity (EI) and wash-in time(WIT) of gastric cancer was calculated manually (EI=PI-BI; WIT=TTP-AT).All of the subjects were divided into two groups according to their lymph nodes status postoperatively:group N1,sixty-nine patients with lymph nodes metastasis; and group N0, forty-seven patients without lymph nodes metastasis.The DCUS quantitative analysis and pathological results of these two groups were compared each other.The Kappa's test was used for inter-rater reliability.Results BI of group N1 in the gastric carcinoma tissues was lower than that of group N0 significantly [(1.41 ± 1.56)dB vs (3.92 ± 2.82)dB, t = - 4.81, P = 0.000].EI of group N1 in the gastric carcinoma tissues was higher than that of group N0 significantly [(20.67±3.71)dB vs (14.12±3.75)dB, t=7.31, P=0.000].Moreover, there was a significant difference of WIT in the gastric carcinoma tissues between these two groups[(9.12±2.99)s vs (10.88±3.05)s, t =-2.43, P=0.018].The WIT in patients with lymph nodes metastasis was shorter than that without it. A cut-off value ＞17.05 dB of EI in gastric cancer tissues for assessing the lymph nodes metastasis had a sensitivity of 80.50% and specificity of 76.70% respectively obtained by the area under the ROC curve. The Kappa value of this method was 0.88.Conclusions EI of gastric cancer tissues can be considered as a new potential index to evaluate the lymph nodes metastasis of gastric cancer.

Objective To investigate the diagnositc value of high frequency ultrasound guided fine needle aspirates (FNA) and thyroglobulin (Tg) in fine-needle aspirate fluid (FNA-Tg) measurement for detecting metastatic lymph nodes in patients underwent thyroidectomy for papillary thyroid carcinoma (PTC).Methods Sixty-five patients with 79 suspected metastatic lymph nodes were retrospective analysis in this study.FNA for suspected lymph nodes was performed guided by high frequency ultrasound and FNATg was measured.The histopathologic diagnosis for all of the suspected lymph nodes was obtained after lymphadenectomy.Results By histopathologic diagnosis,62 lymph nodes were positive metastasis,while 17 were negative metastasis.Fifty-four lymph nodes were diagnosed as positive metastasis and 25 as negative metastasis by FNA.The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of FNA for assessing cervical metastatic lymph nodes from PTC were 89.87％ (71/79),87.10％ (54/62),100％ (17/17),100％ (54/54) and 68.00％ (17/25),respectively.Sixty-five lymph nodes were diagnosed as positive metastasis and 14 as negative metastasis by FNA-Tg.The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of FNA-Tg were 96.20％ (76/79),100％ (62/62),82.35％ (14/17),95.38％ (62/65) and 100％ (14/14),respectively.There was no significant difference between FNA and FNA-Tg for evaluating cervical metastatic lymph nodes from PTC (x2 =1.454,P =0.228).Eight positive metastatic lymph nodes which were missed by FNA were corrected diagnosed by FNA-Tg measurement.Conclusions Both FNA and FNA-Tg are effective methods for assessing cervical metastatic lymph nodes from PTC postoperatively,and these two methods could be combined for early and accurate evaluating the lymph nodes state.

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 the characteristics of left ventrlcular ( LV) systolic syncnrony before and 6 days after percutaneous transluminal septal myocardial ablation(PTSMA)in patients with hypertrophic obstructive cardiomyopathy (HOCM) using two dimensional speckle tracking imaging(2DSTI),and to investigate correlation between the LV systolic synchrony and LV outflow-trace gradient (LVOTG).MethodsLVOTG were measured before and 6 days after PTSMA in 21 patients with HOCM.The two dimensional loop-cinec were obtained in three levels of the short axis views of LV (mitral valve,papillary muscle and cardiac apex).The time from the onset of QRS complexes to systolic peak strain from the radial vectors (TRs) was recorded using 2D-STI.The standard deviation of the TRS of 18 segments (TRsSD) were calculated as indicator of LV systolic synchrony.Results Six days after PTSMA,LVOTG decreased significantly from (84.3 ± 19.1)mm Hg to (40.6 ± 8.3)mm Hg( P ＜0.01).TRS of the base and middle segments of anteroseptal were prolonged dramatically( P ＜0.05) 6 days after PTSMA compared with that before.There were no significantly differences in TRs-SD of LV between before and 6 days after PTSMA ( t =1.03,P ＞ 0.05).Decreased LVOTG correlated moderately to prolonged TRS of the base segments of anteroseptal ( r =0.657,P ＜0.05).Conclusions2D-STI can detect exactly the characteristics of LV systolic synchrony before and 6 days after PTSMA in patients with HOCM.

Objective To explore the correlation of left ventricular systolic function calculated by automated cardiac motion quantification (aCMQ) and three-dimensional quantitative analysis (3DQA). Methods According to LVEF by 3DQA,patients were divided into abnormal cardiac function group(LVEF<50%)and normal cardiac function group(LVEF≥50%).Dynamic images from two chamber view(AP2), four chamber view(AP4)and three chamber view(AP3)of left ventricular long axis were acquired from 32 patients with abnormal cardiac function and 119 normal subjects.AP2 longitudinal strain (AP2LS),AP4 longitudinal strain (AP4LS) and AP3 longitudinal strain (AP3LS) as well as the left ventricular global longitudinal strain (LVGLS) were measured by aCMQ. While left ventricular end diastolic volume (LVEDV),left ventricular end systolic volume (LVESV) and LVEF were derived through aCMQ automatically calculated region of interest (ROI) driven automation.The correlation of left ventricular systolic function indexes obtained by aCMQ and 3DQA were compared.Results No significant differences were found between the two groups in gender,body mass index(BMI) and age (P > 0.05).LVEF in abnormal group by 3QDA and aCMQ were much lower than those in normal group (P < 0.01).The absolute values of AP2LS,AP4LS,AP3LS and LVGLS in abnormal group were significantly lower than those in normal group (P < 0.01).LVEF by aCMQ in abnormal group was positively correlated with LVEF by 3QDA methods(r =0.91 ,P <0.01);LVEF by aCMQ in normal group was positively correlated with LVEF by 3QDA (r = 0.73,P < 0.01).The left ventricular global longitudinal strain (LVGLS) measured by aCMQ was negatively correlated with LVEF by 3QDA(r = -0.815,P < 0.01).LVEF measured by aCMQ and 3DQA showed high inter-observer and intra-observer agreements in Bland-Altman charts.Conclusions aCMQ has preferable repeatability.Comparing with the traditional measurement method,LVEF measured by aCMQ has higher correlation with that measured by 3QDA.aCMQ can be a new and relatively accurate method to evaluate the left ventricular systolic function.

Objective:To establish the prediction model of postoperative Gleason score (GS) risk of prostatic cancer (PCa), and to compare the diagnostic efficacy of the model and each independent risk factor for PCa medium-high risk group.Methods:The clinical data of 362 patients who accepted transrectal prostate biopsy in the Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine from January 2018 to December 2019 were analyzed retrospectively, and a total of 343 patients with prostate cancer who met the enrollment criteria were selected. According to the GS grading system, these patients were divided into low risk group, moderate risk group and high risk group. At first, the single factor analysis and Spearman rank correlation were used to find out the effective indicators with good correlation with GS risk. Then, multiple linear regression equation was applied for multi-factor analysis to obtain the independent risk factors and the prediction model for predicting GS risk, and then the ROC curve was used to compare the diagnostic efficacy of each independent risk factor and prediction model for PCa medium-high risk group.Results:In the single factor analysis, the differences of all indicators in GS risk were statistically significant (all P<0.05). In the correlation analysis with GS risk, except for the indicators of prostate volume (all P>0.05), the other indexes had linear correlations with the different risks of GS (all P<0.05). Among them, the total prostate specific antigen and two-dimensional ultrasound (2D-US) score showed moderate positive correlations( rs=0.402, 0.579, all P<0.001), contrast enhanced ultrasound (CEUS) score showed a high positive correlation ( rs=0.709, P<0.001), and the rest indexes showed low positive correlations. Multiple linear regression was used to obtain two independent risk factors of 2D-US score ( X1) and CEUS score ( X2) for the prediction of GS risk, then, a prediction model was established: Y=0.863+ 0.066 X1+ 0.27 X2, the corresponding linear coefficient differences were statistically significant(all P<0.05). By the ROC analysis, the areas under the curves of 2D-US score, CEUS score and the prediction model were 0.838, 0.906 and 0.907, respectively. Conclusions:2D-US score and CEUS score are independent risk factors for predicting postoperative GS risk, and the diagnostic efficacy of the prediction model is higher than those of the 2D-US score and CEUS score for the medium-high risk group.

Objective To determine whether real-time three-dimensional transesophageal echocardiography(RT-3D TEE) is an accurate non-invasive technique for defining the morphology of atrial septal defects(ASD). Methods In 20 patients with secundum ASD, mean age 42.2 years (7 male, 13 female) ,live three dimensional surgical views of ASD were acquired,qualitative morphology of ASD such as the shape, presence of fenestrations and the defect margins were noted during the cardiac cycle. The measurements obtained from 2-dimensional transesophageal echocardiography(2D-TEE) and RT-3D TEE were compared to those obtained from stretched balloon diameter(SBD) or surgery. Measurements of the size and area change of ASD were validated during the cardiac cycle by RT-3D TEE,stepwise multiple linear regression analysis was performed to test the correlation between the maximum change ratios of area and diameter of ASD and age, atrial septal length, ASD shunting velocity, the maximum diameter of ASD and right ventricular systolic pressure. Results ① The morphology of ASD was circle-like or elliptical in systole,irregular or elliptical in diastole. ②The area and diameter of ASD measured by RT-3D TEE was minimal in isovolumetric contraction phase, maximal in isovolumetric diastole phase. The correlation coefficient of maximum diameter measured by 3D with SBD was 0.962 , greater than that by 2D and SBD (0.820). ③The change ratio of area and maximum diameter of ASD acquired by RT-3D-TEE was 11.48%-71.12% and 2.80%-43.87% respectively,and the correlation coefficient of them was 0.921. Conclusions RT-3D TEE using live 3D-Zoom mode accurately displayed the varying morphology,dimensions and spatial relations of ASD. RT-3D TEE can offer visualization morphological changing of ASD in different periods of cardiac cycle,providing more information for percutanous catheter intervention and open heart surgery.

ObjectiveTo quantitative evaluate the alterations of cardiac morphology and function in gestational impaired glucose tolerance(GIGT) fetuses.MethodsFetal echocardiograms were performed on 68 GIGT fetuses with gestation age between 21 ～ 40 weeks for evaluation of cardiac morphology and function.Fetal cardiac morphology,systolic and diastolic functions of 68 GIGT fetuses were compared with 81 control group fetuses using conventional two-dimensional,M-mode,pulsed Doppler echocardiography and myocardial tissue Doppler imaging.ResultsComprehensive fetal echocardiography data analysis showed no significant differences in cardiac morphology and function between two groups (P＞0.05).Conclusions The alterations of cardiac morphology and function in GIGT fetuses can be accurately and objectively evaluated using quantitative evaluation in fetal echocardiography and will help to offer consultation.

Objective To quantitatively study the correlation of the distance of pulmonary valve to pulmonary artery bifurcation (DPVB) of normal fetuses in second and late trimester with the fetal biometric parameters using fetal echocardiography.Methods The distances of pulmonary valve to pulmonary artery bifurcation in end-systole (DPVBs) and in end-diastole (DPVBd) were measured in a standard short axis view or right ventricular outflow tract view using fetal echocardiography on 419 normal fetuses.The gestation ages ranged from 20 to 35+ weeks.Fetal non-cardiac biometric parameters including biparietal diameter (BPD),femoral length (FL) and gestation age (GA) based on menstrual age,pulmonary valve annulus diameters (PA) at end-systole were measured.The correlation between DPVBs,DPVBd and non-cardiac biometric parameters were analyzed.Results In normal fetuses,the DPVBs was (1.14±0.24)cm with a range of 0.67 to 1.61 cm,the DPVBd was (0.93±0.20)cm with a range of 0.53 to 1.33 cm.The DPVBs and DPVBd were increased with the growth of GA,and were positively correlated with GA,BPD,FL and PA (r=0.827,0.798,0.793,0.769;0.802,0.764,0.773 and 0.771,respectively,all P<0.001).The linear regression equations between DPVBs,DPVBd and GA,BPD,FL,PA were:Y=0.054×GA-0.369,Y=0.184×BPD-0.179,Y=0.217×FL+0.011,Y=1.602×PA+0.156,Y=0.045×GA-0.330,Y=0.152×BPD-0.157,Y=0.182×FL-0.018,Y=1.380×PA+0.080.Conclusions In normal fetuses,the DPVBs and DPVBd increase with the growth of GA,and have good correlation with GA,BPD,FL and PA,respectively.Normal reference ranges of DPVBs and DPVBd have been provided.These normative data may become a new tool for assessment of fetal heart,especially has potential applications in screening of complex congenital heart defects.