Objective To design and construct a hepatocellular carcinoma(HCC) phantom,and assess the accuracy of three dimensional ultrasound (3DUS)-CT image fusion in evaluating ablative margin (AM).Methods The phantom was constructed by carrageenan gel and additives.A sphere-shaped HCC model surrounded by a 5 mm layer of AM model was embedded into a cylindrical-shaped ground substance model to form the phantom.After radiofrequency ablation (RFA),HCC model in the phantom was ablated into ablative lesion model.The ultrasound and CT image,macroscopic appearance and stability of the phantom were observed.Twenty-four phantoms were made and ablated into different ablative lesion models in which AM was achieved or not achieved.Outline the HCC and 5mm AM in the 3DCT image and fuse 3DCT image with the 3DUS image of the ablative lesion model to see whether the ablative area could cover the AM,as well as in which quadrant complete ablation of the AM had not been achieved and the maximal thickness of the unachieved AM.The result of the 3DUS-CT image fusion was compared with gross specimen.Results The ultrasound and CT image,macroscopic appearance and stability of the phantom met the demand of this study.The sensitivity,specificity and accuracy of 3DUS-CT image fusion were 93.8％,85.7％ and 91.3％respectively.The quadrant in which complete ablation of AM was not achieved matched with gross specimen.The maximal thickness of the unachieved AM measured by 3DUS-CT image fusion and gross specimen were (3.5 ± 2.0) mm and (3.2 ± 2.0) mm respectively,and no statistic difference was found between the two results.Conclusions The phantom made of carrageenan gel and additives was suitable for the evaluation of AM.3DUS-CT image fusion evaluation of AM was accurate.

Objective To demonstrate the feasibility and accuracy of the intellectual position(IP)technique used in ultrasound-guided biopsy.Methods Several red spheres,which were 10 mm in diameter and visible in ultrasound,randomly placed in the tissue mimicking gel phantom.The biopsy was performed by two operators respectively.Each operator chose 25 spheres,each of which were performed biopsy guided by IP technique,free-hand ultrasound and ultrasound with guide bracket.The red dye in the biopsied sample meant successful performance.The time spend in per biopsy target,the success rate of biopsy and the length of the red dyed sample of the three methods were recorded,and comparison was made among them.Results The median time took in biopsy guided by IP technique was 95(rang,80-110)s,which was longer than that of free-hand ultrasound-guide[30 (rang,22-42) s,P ＜0.001] and ultrasound-guide with bracket [20(rang,15-28)s,P ＜0.001].The success rate of biopsy guided by IP technique was 98.0％ (49/50)which was as well as that guided by ultrasound-guide with bracket(96.0％,48/50,P =0.558),better than free-hand ultrasound-guide(78.0％,39/50,P =0.002).The median length of red dyed sample biopsied guided by IP technique was 8.0 (rang,7.0-8.5)mm,which was longer than that of free-hand ultrasoundguide[6.0(rang,4.0-8.0)mm,P =0.003] and ultrasound-guide with bracket[7.0(rang,6.0-8.0)mm,P =0.003].There was no statistically difference between the two operators in length of red dyed sample and success rate of biopsy guided by IP technique(P ＞0.05).Conclusions Biopsy guided by IP technique is a feasible and accuracy method,which will become an effectively supplement of the ultrasound-guide with bracket.

Objective To evaluate the value of virtual navigation assisted 3-D contrast-enhanced ultrasound (VNA-3D-CEUS) in depicting ablative area and ablative margin after hepatocellular carcinoma radiofrequency ablation. Methods Sixty-one lesions in 51 patients were evaluated ablative area and ablative margin using VNA-3D-CEUS. The results were divided into three groups: (A) tumor was completely ablated and 5 mm ablative margin was achieved; (B) tumor was completely ablated but 5 mm ablative margin was not achieved; (C) tumor was not completely ablated. The technical successful rate of VNA-3D-CEUS,as well as the coincidence rate of complete ablation with contrast-enhanced MRI,was evaluated. The relation between local tumor progression and ablative margin was observed through follow-up. Results The technical successful rate of VNA-3D-CEUS was 78.7％ (48/61). Coincidence rate of complete ablation with contrast-enhanced MRI was 100％ (40/40). The local tumor progressions of group A and group B were 0/26 and 2/13. There was significant difference between A and B group( P =0.032). Significant correlation between local tumor progression and ablative margin was found ( r =- 1. 000, P ＜0. 001 ). Conclusions VNA-3D-CEUS could be a new method in accurately evaluating the ablative area and ablative margin after hepatocellular carcinoma ablation.

ObjectiveTo verify the feasibility and the accuracy for the biopsy of targets not visible on sonography but shown on CT in a phantom by using real-time virtual navigation system(RVS).Methods The tissue mimicking phantom,made of gel,contained 30 red spheres which were 10 mm in diameter,randomly placed.These spheres were invisible on sonography,but visible on CT.A junior operator and a senior operator performed the biopsy respectively,and each sphere was biopsied once guide by both RVS and conventional ultrasound for each operator.The red dye in thebiopsied sample meant successful performance.The success rate of biopsy and the length of the red dyed sample were recorded.Results There was no statistically difference between the performance results of the two operators.The success rate and the median length of red dyed sample biopsy of RVS were respectively 96.7％ (58/60) and 7.5 mm (rang,6-9 mm) which were statistically higher and longer than that of conventional ultrasound,43.3％(26/60) and 0 mm(rang,0 - 5 mm) ( P ＜0.05).ConclusionsBiopsy guided by RVS for the target invisible to ultrasound is a feasible and accuracy method,which will be a new guided method for interventional ultrasound.

ObjectiveTo assess the diagnostic performance of contrast-enhanced ultrasound(CEUS)in characterization of adnexal masses in comparison with baseline ultrasound.MethodsOne hundred and thirty-seven masses were examined by CEUS and baseline ultrasound.Two independent investigators reviewed the images before and after contrast agent administration.The diagnostic performances were evaluated using receiver operating characteristic (ROC) analysis and the interobserver agreement was analyzed.ResultsAfter review of CEUS,ROC analysis revealed significant improvement in differentiating between malignant and benign pelvic masses that the areas under the ROC curve were 0.731 and 0.738 at baseline ultrasound versus 0.891 and 0.903 at CEUS ( P ＜0.01 ).The accuracy for both investigators also improved significantly after reviewing CEUS.A better interobserver agreement was achieved after reviewing of CEUS (g =0.681 at baseline ultrasound versus κ =0.893 at CEUS) and a better result of specific diagnosis was obtained (73.2％ and 74.2％ at baseline ultrasound versus 90.7％ and 91.2％ at CEUS)(all P ＜ 0.01 ).Conclusions Real-time CEUS improves the diagnostic performance in adnexal masses for discrimination between malignancy and benignity and improves the capability in specific diagnosis compared with baseline ultrasound.

Objective To assess the diagnostic performance of contrast-enhanced ultrasound in characterization of pelvic masses.Methods Contrast-enhanced ultrasound was performed on 137 patients with pelvic masses.The results were compared to pathological diagnostic criteria.The diagnostic performance was evaluated by using diagnostic test.Results Sensitivity,specificity,positive predictive value,negative predictive value,accuracy and area under ROC curve in diagnosing complex pelvic masses by using contrast-enhanced ultrasound were as follows:85.3％ (29/34),93.2％ (96/103),80.6％ (29/36),95.0％ ( 99/101 ),91.2％ ( 125/137 ),0.892,respectively.Conclusions Contrast-enhanced ultrasound provides a simple and curate method for characterization of pelvic masses.

Objective To evaluate virtual navigation assisted contrast-enhanced ultrasound(VN-CEUS) by comparing VN-CEUS with routine CEUS in detecting focal liver lesion(FLL) invisible in B-mode ultrasound(BUS).Methods Forty-seven FLLs invisible in BUS were identified by CT/MR,and received VN-CEUS and routine CEUS respectively.Results The detection rate of VN-CEUS and routine CEUS were 78.7%(37/47) and 36.2%(17/47),the former was much higher than the later (P<0.01).In all the cases,fusion of CT/MR with ultrasound was achieved successfully and average time for image fusion was 5 min.compared with routine CEUS,VN-CEUS could more easily find FLLs shadowed by lung or ribs,FLLs in inhomogeneous liver background,and FLLs with brief or inapparent abnormal enhancement.ConclusionsVN-CEUS can greatly improve the detection rate of FLL that was invisible in BUS.

Objective To assess the feasibility and accuracy of the transvaginal three-dimensional hysterosalpingo-contrast sonography(3D HyCoSy) on the fallopian tube patency. Methods 3D HyCoSy was performed in twenty-two cases with infertility. Image quality of 3D HyCoSy was evaluated. The estimate of the fallopian tube patency in 3D HyCoSy were compared with those of hysterosalpinography(HSG) in one week. Results The mean score of image quality of 3D HyCoSy in twenty-two cases was 2. 8 + 0. 5. The accuracy of the unobstructed and obstructed fallopian tube were 88.9% (24/27) and 94.1% (16/17) respectively, and the total accuracy was 90. 9% (40/44) , which was equal to the results of HSG (P = 0. 000,k = 0. 812). No adverse reactions of SonoVue occurred in the cases. Conclusions Transvaginal 3D HyCoSy which is a new imaging technique can safely and effectively display the morphological character of fallopian tube and assess the patency.

Objective To explore the value of contrast-enhanced ultrasound (CEUS) in the differential diagnosis of subserous myoma (SM) and ovarian fibroma.Methods CEUS was performed on 58 patients with SM and 26 patients with ovarian fibroma.The enhancement pattern was observed.The diagnostic performance was evaluated by using diagnostic test.Results SM exhibited homogeneous isoenhancement synchronously with the myometrium in early phase.In the late phase,the pseudocapsule remained hyper-enhancement with obvious membraniform sign.Some myomas showed the feeding artery from uterus.Ovarian fibroma demonstrated hyper-enhancement at the periphery portion and hypoenhancement inside.Conclusions The SM and ovarian myomas showed different enhancement patterns,which may provide us some exact information in the differential diagnosis between the two diseases.

Objective To compare the accuracy,convenience and repeatability of 3DUS-US and CT-US image fusion technology based on electromagnetic positioning.Methods A tissue-mimicking phantom was established and used to obtain ultrasound or CT volume images.Two different operators performed 3DUS-US and CT-US image fusion and repeated 10 times,respectively.The success rate,the registration error distance and fusion time of two techniques were recorded and compared between the different operators.Results The ultrasound and CT images of the phantom and its stability could meet the demands of this experiment.3DUS-US and CT-US image fusions were successful.The registration error distance of 3DUS-US image fusion was (1 .70 ± 0.42)mm and fusion time was (76.00 ± 9.99)s,they were obviously superior to CT-US (P = 0.014,P < 0.001 ).There were no significant differences between the two operators in the registration error distance and fusion time of 3DUS-US (P =0.508,P =0.5 1 7).But the registration error distance of CT-US image fusion in experienced operator was lower than the junior (P =0.009),and fusion time had not statistical difference between the two operators (P =0.234).Conclusions The technique of 3DUS-US automatic image fusion based on electromagnetic positioning has advantages of convenience and no experiential dependence comparing with CT-US in the phantom experiments,so it is worthy of being widely popularized in clinical application.