Objective To discuss color Doppler uhrasonographic (CDU) grading of varicocele (VC) in predicting the changes of the fertility index (FI) after varicocelectomy.Methods One hundred and fifty-one patients with VC were diagnosed and graded by CDU.All patients were grouped by the regurgitant volume and the maximum diameter of pampiniform plexus veins(PPV).The relation between the regurgitant volume and the maximum diameter of PPV and the changes of the FI after varicocelectomy was analyzed.Results The pathological regurgitation could be detected when the PPV diameter > 1.5 mm.The positive correlation was observed between the regurgitant volume and the diameter of PPV (r = 0.89, P <0.01).The pre- and postoperative FIs were extremely significant difference in regurgitation grade Ⅱ and regurgitation grade Ⅲ (P < 0.01) but not significant difference in regurgitation grade Ⅰ (P>0.05).The pre- and postoperative FIs were no significant difference in the group with the PPV diameter ≤ 2.0 mm (P > 0.05), but statistically significant difference in the groups with the diameters 2.1-2.5 mm and 2.6-3.0 mm (0.01 < P <0.05).FIs in the group with the diameter > 3.0 mm exhibited extremely significant difference after varicocelectomy (P < 0.01).Conclusions CDU grading of VC could be used to predict the changes of seminal quality after varicocelectomy.Varicocelectomy isn't necessary to the patients with VC that the PPV diameter ≤ 2.0 mm or pathological regurgitation being detected only on Valsalva maneuver.

Objective To discuss the value of color Doppler ultrasonography in the diagnosis and differential diagnosis of urinary tract urothelial carcinoma (UTUC).Methods Color Doppler ultrasonography exam was practiced in 84 UTUC patients preoperatively.According to ultrasound characteristics,lesions was classified into nodular type,wall thickening type and solid mass type,which were confirmed by pathology in all cases postoperatively.Results In the total of 84 cases (76 transitional-cell carcinoma,5 adenocarcinoma and 3 epidermoid carcinoma),lesions infiltrated laminae propria and surrounding tissue in 65 cases.In the nodular type of UTUC,there were nodules raising into lumen.Wall thickening type of UTUC was characterized by irregularly wall thickening,lumen narrowing,truncating and breaking.Similarly,obstruction broke off the ureteral lumen suddenly in solid mass type of UTUC.A clear demarcation could be found between the pipe wall and surrounding tissue in nodular type.However,such clear demarcation could not be found in wall thickening type and solid mass type.The accordance rate of ultrasonographic located diagnosis were 92.9 ％ (78/84),with 6 missed diagnosis cases.The accordance rate of qualitative diagnosis were 89.7％ (70/78).Conclusions As result of color Doppler ultrasonography,there were different relationship between lesion and the peripheral tissue in different types of UTUC.In types of wall thickening and solid mass,the demarcation was unclear and it is easier to violate the surrounding tissue.Color Doppler ultrasonography can provide more effective information for diagnosis and therapy UTUC.

Objective To investigate the dependability between ultrasonic appearances of different degree of acute testicular hemodynamic disorder and contralateral testicular damage.Methods Thirty two white rabbits were randomly divided into 4 groups.Group A-C were subjected to testicular ischemia and color Doppler sonography were continuoully performed in each case.The testes were reperfused when the ultrasonic appearances were as follows:homogeneous appearance with reducing of blood perfusion(group A),increased echogenicity and heterogeneity with little blood perfusion(group B).inhomogeneous appearance with small pieces of low echogenic areas and no blood perfusion(group C).Group D was the control group.Histologic structure changes of contralateral testes were observed after reperfusion for a month.The contralateral testes in all the cases underwent contrast-enhanced ultrasonography(CEUS)before reperfusion of unilateral testes.Results CEUS time-intensity curve of contralateral testes showed no statistical significance between the four groups(P＞0.05).Focal and mild pathological and ultrastructural changes were observed in contralateral testes in group A-C.But Johnsen score showed no statistical significance between the control group and group A-C(P＞0.05).The total number of appotosis cells per 100 seminiferous tubules in group B(38.75±8.88)were significantly more than the control group(18.63±3.81)as well as group A(20.50±6.12)and group C(18.00±4.47)(P＜0.001),but there were no statistical significances between group A,group C and the control group(P＞0.05).Conclusions Ultrasonic appearances of acute testicular hemodynamic disorder are help for the prediction of contralateral testicular damage.As blood flow in contralateral testes were unaffected after acute testicular hemodynamic disorder,it seems to have no role in contralateral testicular damage.

Objective To explore the way of contrast-enhanced ultrasound(CEUS)and quantitative analysis technology to assess testicular microvascular ischemia-reperfusion inj ury.Methods Twenty-four healthy adult rabbits were randomly divided into the control group and the microvascular mild,moderate, serve ischemic inj ury group (group Ⅰ,including group Ⅰ1 ,Ⅰ2 ,Ⅰ3 ).The spermatic cord of the control group were threaded but not ligated.The group Ⅰ1 ,Ⅰ2 ,Ⅰ3 were reperfused 2 h after 2 h,4 h,6 h complete testicular ischemia respectively.The ultrasound contrast angiographic parameters of each group were analyzed by the quantitative analysis techniques,including peak intensity(PI),time to peak(TP),slope,mean transmit time(MTT),DT/2 and area.The levels of plasma vWF,NO and ET-1 were tested after the CEUS. The pathological changes of the ipsilateral testicular were observed by the HE and immunohistochemical staining.Statistical analysis was performed by SPSS 13.0 software.Results Preoperativeiy,each parameter of the experimental group and the control group showed no statistical significance (P > 0.05 ). Postoperatively,the PI,slope,area of the group Ⅰ1 increased significantly,while the TP,MTT were prolonged(P <0.05).Contrast time-intensity curve was significantly higher peak and retrusion.The groupⅠ2's PI,slope,area increased further,DT/2 was significantly prolonged,but TP significantly reduced (P <0.05).The contrast curve significantly increased,forward and decreased slowly.The contrast curves of the group Ⅰ3 was approximate a straight line.The vWF,NO,ET-1 levels of each experimental group were significantly higher than those in control group (P <0.05),among them,the levels of group Ⅰ2 were the highest (P <0.05 ).With the aggravation of ischemia,the testicular capillaries expansion,erythrocyte sedimentation,leakage,infiltration of inflammatory cells,MMP-9 expression in vascular basement membrane gradually increased.Conclusions The CEUS and quantitative analysis techniques can effectively evaluate testicular microvascular inj ury.

Objective To detect high-frequency ultrasound and clinical features of acute scrotum in children. Methods High-frequency ultrasound and clinical manifestations of 112 children with acute scrotum were analyzed and compared with the final diagnosis and therapeutic regimen.Results Torsion of appendage with uneven echo nodular near the upper pole of testis or head of epididymis, accompanying secondary reactive inflammation or not were detected in 65 children. Complete testicular torsion was found in 21 children who had the whirlpool sign and absent flow in the affected testicle. There was incomplete torsion in 4 patients with winding courser sign and some flow with low resistant index. Flow increased in 22 children with acute epididymo-orchitis, except 1 with suppurative orchitis. The ultrasonic diagnose accordance rate was about 98.21% (110/112). The clinical manifestations of acute scrotum had some characteristics though partial overlapping exited. Fifteen children with torsion of appendage, 25 with complete torsion and 1 with acute orchitis received operation, and the other received expectant treatment.Conclusion The objective and precise emergency ultrasonic diagnosis combined with the overall and profound analysis of related clinical data may provide important information for the diagnosis and treatment of acute scrotum in children.

Objective To study the impact of ultrasound contrast agent with different doses or imaging modes on rabbit spermatogenic cell in the diagnosis of radiation dose.Methods Thirty-three New Zealand white rabbits were randomly divided into 3 groups.In group Ⅰ ,three minutes gray scale ultrasound radiation was performed for three rabbits.In group Ⅱ, SonoVue was bolus injected from ear vein for eighteen rabbits.The rabbits in this group were divided into 6 sub-group according to different doses and different sampling times, the single injections of SonoVue with dosage of 0.1 ml/kg(A1, A2) or 1 ml/kg (C1 ,C2) and repeated injections with dosage of 0.1 ml/kg interval 15 min (B1 ,B2) were taken.In group Ⅲ ,twelve rabbits were bolus injected with SonoVue and then the agent bubbles were blasted when the SonoVue suffused the whole testis.The rabbits in this group were divided into 4 sub-groups according to different doses and different sampling times, and the dosages of SonoVue were 0.1 ml/kg(D1, D2) and 1 ml/kg(E1,E2).Testis were drew immediately or 24 hours later for the observation under light microscope and transmission electron microscope.Results Apoptotic cells in group Ⅲ were more than those in group Ⅰ and Ⅱ ( P ＜0.05) ,while no significant difference of the total number of apoptotic cells between group Ⅰ and Ⅱ ( P ＞0.05).The appearances of focal ultra-structural damage were observed by transmission electron microscope in group C1, such as intercellular space widening and mitochondria swelling, and no distinct damage were observed in the other groups.The appearances of intercellular space widening, mitochondria swelling and cellular edema were observed by transmission electron microscope in group Ⅲ, and spotty necrosisetc was also observed in group D1 and E1.Conclusions Large dose of contrast agent could cause germ cells slight instantaneous effects, while conventional dose had no effect.Contrast agent blasting may cause germ cells unrecoverable damage.

Objective To investigate the value of predicting testicular viability following unilateral testicular torsion by color-Doppler ultrasound (CDU). Methods The clinical manifestations, intraoperative findings and scrotol CDU appearances before and after operation of 42 cases with testicular torsion were compared. According to a bleeding test intraoperatively, testicular viability was divided into A-D level. Testis of level A-C would be saved .while the level D removed. Testicular viability assessed by follow-up CDU was then classed into Ⅰ-Ⅲ level. In Ⅰ-Ⅱ level, the salvaged testis were recovery ultimatelybut atrophy in level Ⅲ. Results Seventeen cases of the 42 underwent orchidopexy and the remaining 25 cases underwent orchidectomy. As followed up, however, testis in only 7 cases were recovered, including 2 cases in level A,3 cases in level B and 2 cases in level C. respectively. The preoperative scrotal CDU appearances of the recovered testis were mainly as follows: ① Homogeneous parenchyma with decreased or disappeared blood perfusion. ②Sheet or radial hypoechoic in the local testis but with preserved blood perfusion in most area else. Testis in the remaining 10 patients, including 8 cases in level C and 2 cases in level D, respectively, were atrophy finally. And large radial hypoechoic or diffuse inhomogeneous echo with none or a small amount of blood supply on the edge parenchyma were found during their preoperative CDU (similar CDU performance was present in the orchidectomy group. The CDU appearances of contralateral testes both in orchidopexy and orchidectomy group were not obviously abnormal during follow-up. Conclusions The scrotal CDU examination is competent to predict testicular viability after detorsion. In addition, timely operation would be a key to CDU evaluation.

Objective To probe the differential diagnostic value of color Doppler ultrasonography(CDU)in cystitis glandularis.Methods Thirty-nine cystitis glandularis and 192 bladder cancer were examined with CDU.The location,shape,boundary,internal echo and relationship with wall of urinary bladder of lesion were observed.Internal blood flow disposition of lesion were detection.The results of CDU were compared with those of cistoscope biopsy and pathologic diagnosis after operation.Results 59.0%(23/39)cystitis glandularis and 52.9%(74/140)bladder cancer lesions located in trigone of bladder and surrounded the orifice of ureter.53.8%(21/39)cystitis glandularis showed part wall thickening and 72.9%(140/192)bladder cancer showed single nodus or bolus.Sacculiform anechoic area were observed in 69.2%(27/39)cystitis glandularis and were not observed in bladder cancer.Punctiform hyperechogenicity appeared in periphery of 48.4%(93/192)bladder cancer and 7.7%(3/39)cystitis glandularis.The detection rate of interior blood flow signal of bladder cancer was 84.9%(163/1 92),which was obviously higher than that of cystitis glandularis.The diagnostic accurate rates of CDU in cystitis glandularis and bladder cancer were 84.6%(33/39)and 95.3%(183/192),respectively.Conclusions CDU can clear display the location,shape,boundary,internal echo and relationship with wall of urinary bladder of cystitis glandularis and is of important value in diagnosis,differential diagnosis and clinical fllow-up of cystitis glandularis.

Objective To probe the clinical diagnosis value of high frequency ultrasonography (HFUS) in thyroglossal duct cyst(TDC). Methods Forty-one TDC were taken HFUS and the location, boundary,shape,interal echo of lesions and the relation to hyoid bone were observed. The periphery and internal blood flow signal were detected by color Doppler flow imaging. The results of HFUS were compared with those of pathology after operation. The cases were divided into groups according to pathological types and were compared with acoustic image shows. Results All cases were diagnosed TDC by pathology after operation. Internal walls of 9 TDC consist of cilium columnar epithelium, 19 consist of stratified pavement epithelium and 13 consist of this two epitheliums. HFUS showed different pathological types had different ultrasonic appearances. In this study, 77.8%(7/9) TDC with columnar epithelium showed echoless,84.2 (16/19) TDC with pavement epithelium showed similar solid echopattern and TDC with two epitheliums mainly showed similar solid echopattern and multi-room cyst. Hyperechogenicity of hyoid bone displayed around the lesion in 80.5%(33/41)TDC. No blood flow signal showed in 41 TDC and a little punctiform blood flow signal showed in the periphery of 5 TDC. The diagnose accordance rate of HFUS in TDC was 95.1%(39/41). Conclusions HFUS can clearly show the location, boundary, shape,interal echo of TDC and its relation to hyoid bone. HFUS is important for diagnosis and differential diagnosis of TDC.

Objective To probe the value of color Doppler ultrasonography (CDU) in differential diagnosis of the pure mucinous adenocarcinoma of breast (PMAB) and adenofibroma of breast (AFB).Methods Twenty-five cases of PMAB and 30 cases AFB were examined by CDU. The sonographic appearance, interior and peripheral blood flow distribution and Doppler frequency of the tumors were observed and analyzed. The results of the diagnoses of CDU and the pathologies were compared. Results The diagnostic rates of PMAB and AFB by CDU were 76.0% and 93.3%, respectively. The clear peplos was observed in 90% of AFB, and internal even echoes. Yet no peplos was observed in PMAB, and the internal echoes of most PMAB were confused and disordered. The detection rate of Ⅰ ～ Ⅱ stage blood flow in adenofibroma of breast was only 40% and that of Ⅰ ～ Ⅲ stage blood flow in PMAB was high to 76%.The detection rate of blood flow stage and the resistant index (RI) of the blood flow frequency spectrum of PMAB and AFB were significantly different. Conclusions CDU has significant clinical value in differential diagnosis of pure mucinous adenocarcinoma and adenofibroma of breast.