Objective To investigate the clinical value of color doppler ultrasonography(CDU) to extracranial vertebral artery stenosis before and after percutaneous transluminal angioplasty and stent(PTAS) treatment.Methods 61 patients with extracranial vertebral artery stenosis confirmed by digital subtraction angiography(DSA) were detected by CDU on both sides of extracranial vertebral artery before and 3 d,30 d after PTAS.The flow volume(FV),peak systolic velocity(PSV) and resistance index(RI) at the site of C5-C6 segment and stenosis were as analysis targets.Results Before PTAS,80 stenotic extracranial vertebral arteries were found by CDU(mild degree 17 cases,moderate degree 38 cases,severe degree 25 cases).Compared with DSA,coincidence was 86.9%(77.3%,95.0%,83.3%).Among them,the coincidence of moderate extracranial vertebral artery stenosis detected by CDU was excellent(P0.05).Conclusion CDU has the important value in diagnosing extracranial vertebral artery stenosis,and can be used to follow up the blood hemodynamics in the extracranial vertebral artery of patients treated by PTAS.It provided a method for observing the efficacy of PTAS treatment.

Objective To evaluate the diagnostic value of ultrasonography on thyroid microcarcinoma ,and to find out its sono-graphic characteristics .Methods Ultrasound performance of 206 thyroid microcarcinoma nodules in 150 patients confirmed by sur-gery and pathology were retrospectively analyzed ,nodules internal echo ,boundary ,the shape ,the blood flow and internal calcifica-tion and calcification size ,distribution and type were observed and compared with 82 benign nodules(diameter ≤1 cm) .Results In terms of solid low echo ,minicalcification ,aspect ratio≥1 ,rich blood flow and neck lymph node enlargement ,thyroid microcarcinoma were significantly higher than that of thyroid benign nodules (P<0 .05) .Ultrasonographic performance of thyroid microcarcinoma often presented as solid low echo ,irregular form ,aspect ratio ≥1 ,internal mostly small calcification ,edge blur and the surrounding small burrs .Color doppler blood flow showed that ,blood supply was rich in patients with strong nodules ,distribution was irregular , smaller nodules blood flow was not rich .Conclusion The two-dimensional and color doppler flow imaging(cdfi) might be has a im-portand value on thyroid microcarcinoma diagnosis .

Objective In clinical practice,ultrasound-guided fine-needle aspiration biopsy (US-G FNAB) is the gold standard in diagnosing the pathological nature of undetermined thyroid nodules before operation.Re---sults of FNAB may vary substantially among operators with different skills.The aim of this study is to evaluate whether operator experience in US-G FNAB influences the rate of diagnostic procedures.Methods A total of 600 consecutive US-guided FNAB done by a single radiologist with 22-or 27-gauge needles from Feb.2008 to Apr.2012 were retrospectively analyzed.All specimens were prepared and fixed without the cytologist on site and were subsequently analyzed by 2 expert cytologists.The procedures were chronologically divided into 6 groups and further stratified according to the overall (A),solid nodules (B),mixed nodules (C),pure cystic nodules (D),acellular sample(E),heavily blood-stained sample(F),exclusively colloid material(G),incorrect slide fixation(H) and they were classified as diagnostic or no-diagnostic.Results The rate of no-diagnostic procedures for each group in learning curves were reported as:① Among A,34％ in group 1,15％ in group 2,18％in group 3,10％ in group 4,7％ in group 5,and 8％ in group 6.② Among B,4％ in group 1,1％ in group 2,0％ in group 3,0％ in group 4,0％ in group 5,and 0％ in group 6.② Among C,10％ in group 1,1％ in group 2,4％ in group 3,0％ in group 4,1％ in group 5,and 0％ in group 6.④ Among D,20％ in group 1,13％ in group 2,14％ in group 3,10％ in group 4,6％ in group 5,and 8％ in group 6.⑤ Among E,25％ in group 1,15％ in group 2,15％ in group 3,10％ in group 4,6％ in group 5,and 8％ in group 6.⑥ Among F,4％ in group 1,0％ in group 2,1％ in group 3,0％ in group 4,0％ in group 5,and 0％ in group 6.⑦ Among G,1％ in group 1,0％ in group 2,1％ in group 3,0％ in group 4,1％ in group 5,and 0％ in group 6.⑧ Among H,4％ in group 1,0％ in group 2,1％ in group 3,0％ in group 4,0％ in group 5,and 0％ in group 6.Among the 600 procedures,there were 2 cases of vertigo and 4 cases of moderate bleeding at the biopsy site,all of which resolved spontaneously.No major complications were recorded.Conclusions The rate of no-diagnostic US-guided FNAB is heavily dependent on the operator's experience.We estimate that at least 200 procedures are needed in order to achieve the levels of diagnostic accuracy reported in the literature.We therefore suggest operators to get specific training before routinely perform this procedure in clinical practice.

Objective To investigate the significance of sonographic patterns of thyroid calcification in diagnosis of thyroid nodule.Methods 235 patients with 355 thyroid nodules were retrospectively analyzed.Nodule calcification size,distribution and pattern were observed.Results The incidence of calcification in benign and malignant nodules was 30.3％ (89/294)and 73.7％ (45/61) respectively.The difference had statistical significance(x2 =24.3,P ＜0.01).The rate of microcalcification in cancer was 47.5％ (29/61),higher than that in benign one 3.1％ (9/294)(x2 =99.1,P ＜ 0.01).Coarse calcification in benign nodules and malignant lesion was 27.2％ (80/294)and 26.2％ (16/61)respectively.The difference had no statistical significance(x2 =0.42,P ＞0.05).Conclusions Microcalcification of thyroid nodules is a specific index for thyroid carcinoma.Any type of sonographically detected calcification represents risk of malignancy.Not only microcalcification,these cases should raise the suspicion of malignancy in coarse calcification,especially involving a solitary nodule and irregular shape.

ObjectiveTo compare the performance of color Doppler utrasonography (CDUS) alone,magnetic resonance imagine (MRI) alone, and the combination of the two in the diagnosis of thyroid carcinona (TC). MethodsCDUS and MRI results of 54 focuses of carcinoma in 45 cases diagnosed as TC by postoperative pathological results were reviewed. The sensitivity of CDUS, MRI, and the combination of the two in the diagnosis of TC was compared. ResultsThe sensitivity of CDUS and MRI was 77.78％ (42/54)and 81.48％(44/54) respectively. The difference had no statistical significance (P ＞ 0.05 ). The specificity of CDUS and MRI was 88.17％ and 92.47％ respectively, the positive predictive value was 79.25％ and 86.27％ respectively,and the negative predictive value was 87.23％ and 89.58％ respectively. The sensitivity of the combination of CDUS and MRI was 94.44％ (51/54). The difference between the combination and CDUS or MRI alone had statistical significance( P ＜0.05). ConclusionsCDUS has higher detection rate than MRI in microcalcification of TC focus. However, MRI can show more clearly of the peripheral invasion and cervical lymph node metastasis.The combination of the two can improve the accuracy of TC diagnosis.

Objective To explore the value of color Doppler ultrasonography(CDU)as preoperative diagnosing and postoperative monitoring in patients with stenosis of subclavian or innominate artery(SIA)before and after percutaneous transluminal angioplasty and stent(PTAS).Methods A total of 45 patients with stenosis of SIA were selected.Their extracranial vertebral artery and subclavian artery were observed with CDU.In 36 patients with one-sided stenosis of SIA.blood flow direction and spectrum of extracranial vertebraI artery were analyzed.Subclavian steal grade confirmed by spectrum change of vertebral artery was compared with the stenosis grade on quantitative angiography(QA).Among 45 patients with stenosis of SIA,PTAS was performed successfully in 36 patients(36 stents implanted).After stents implanted, hemodynamie parameters such as peak systolic velocity(PSV)in stent, follow-up velocity ratio in stem(VR)were measured.Restenosis in stent were observed.Results In 36 patients with one-sided stenosis of SIA,the ultrasonographic steal grade correlated with the QA stenosis grade significantly(r=0.752,P<0.01).Among 36 patients with stent implanted,follow up 8-12 months, 4 patients with restenosis in stent were found.Compared with the patients without restenosis in stent,PSV and VR in stent increased significantly(P<0.01).Conclusions As a fast and non-invasive imaging technique,CDU could allow diagnosis of stenosis of SIA before PTAS,and detection of restenosis after PTAS.

Objective To evaluate myocardial systolic rotation with speckle tracking imaging in multiple myeloma (MM) patients with normal left ventricular ejection fraction (LVEF).Methods A total of 42 patients with MM (LVEF≥50％) and 30 healthy controls (control group) were included,and the general and 2D echocardiographic parameters were analyzed.MM patients were divided into normal ventricular wall group (n=14) and thickened ventricular wall group (n=28).Results At mitral valve level,the subendocardial myocardium rotation and the whole myocardium rotation in normal ventricular wall group and thickened ventricular wall group reduced compared with those in control group (all P＜0.05).At apical level,the subendocardial myocardium rotation and the whole myocardium rotation in thickened ventricular wall group reduced compared with those in control group (both P＜0.05),and the differences of the subendocardial myocardium rotation and the whole myocardium rotation were not statistically significant between normal ventricular wall group and control group (both P＞0.05).LV torsion in normal ventricular wall group and thickened ventricular wall group reduced compared with control group (both P ＜ 0.05).The differences of subepicardial myocardium rotation were not significant neither in mitral valve level nor in apical level among three groups (P＞ 0.05).Conclusion LV rotation in patients with MM has been impaired before the appearance of characteristic echocardiographic changes,especially in subendocardial myocardium.

Objective To investigate the safety and efficacy of microwave ablation guided with laparoscopy and transvaginal ultrasound in the treatment of adenomyosis.Methods Seventy patients with 89 lesions of adenomyosis were treated with laparoscopy and transvaginal ultrasound guided microwave ablation.Intraoperative and postoperative complications were observed.The differences in dysmenorrhea score,menstrual flow and dysmenorrhea time before and after treatment were compared.Ultrasound examinations were performed 1,3 and 6 months after treatment to measure the volumes of uterus and adenomyosis lesions.Results Outflow liquid from vagina 1-3 days after treatment was found in 1 patient,and mild vaginal bleeding was found in 3 patients.No serious complication occurred in the other 66 patients.Compared with preoperation,the dysmenorrhea score,menstrual flow and dysmenorrhea time decreased in all patients after treatment (all P＜0.01).The volumes of uterus and adenomyosis lesions 1,3 and 6 months after treatment were significantly less than those before treatment (all P＜0.01).Conclusion Laparoscopy and transvaginal ultrasound guided microwave ablation is a safe and efficient therapy for adenomyosis.

Purpose To explore the short-term clinical efficacy and application value of transvaginal sonography-guided laparoscopic percutaneous microwave coagulation therapy in the treatment of uterine adenomyoma.Materials and Methods Forty patients with uterine adenomyoma who visited the Central Hospital of Wuhan from October 2015 to October 2016 were selected in this study.These patients were invalid in traditional treatment for severe dysmenorrheal,but still unwilling to excise uterus.Microwave needles were placed into uterine adenomyoma to conduct percutaneous microwave coagulation therapy under the whole-process monitoring and guidance of laparoscope and transvaginal ultrasonography.Results All of 64 nidi in the 40 patients were ablated successfully,and none had damage to peripheral vital organs or vessels.Intraoperative hemorrhagic volume was extremely small.Postoperative menstrual blood volume and dysmenorrheal severity were improved notably,but none had obvious recurrence until now.The uterine volumes at postoperative one,three and six months as well as one year were (135.0±73.2) cm3,(108.2 ± 62.9) cm3,(91.4 ± 58.4) cm3,and (84.8 ± 50.0) cm3,respectively,all were evidently smaller than the (207.2± 97.4) cm3 before operation (P＜0.01).The n idus sizes at postoperative one,three and six months as well as one year were (42.3±34.2) cm3,(30.6±27.4) cm3,(24.7±23.0) cm3 and (23.0± 19.4) cm3,respectively,all were evidently smaller than the (67.9±48.2) cm3 before operation (P＜0.01).There were also significant differences in laboratory examinations of CA125 and CA199 before and after operation (P＜0.01).Conclusion Percutaneous microwave coagulation therapy as a non-invasive technique that can both maintain patients' uteruses and resolve their pain,is more safe and real-time under the monitoring of laparoscope,thus being promising as a new routine for the treatment of uterine adenomyoma.