Arterial stenosis-induced hemodynamic changes and their evaluation have long been studied by lots of scholars by in vivo and in vitro experiments,clinical observation and improved experimental devices and methods,which has contributed a lot to the diagnosis and treatment of arterial stenosis.This review describes the current research results.

Objective To observe and evaluate the effect of ultrasound guided percutaneous ethanol injection for hyperparathyroidism secondary to chronic renal failure. Methods Fifty-three patients with secondary hyperparathyroidism in Nanjing General Hospital Military Command from January 2011 to May 2013 were treated by percutaneous ethanol injection. The echogenicity, size and blood supply of parathyroid glands were observed by color Doppler ultrasound before and after treatment. Parathyroid hormone (PTH) and volumes of parathyroid glands were analyzed and compared with non-paired t test. Results Before treatment, the parathyroid gland volume was (5.28±0.84) cm3. The enlarged parathyroid glands had homogeneous hypoechogenicity and abundant blood supply, and the PTH was (1041.6±37.1) ng/L. After treatment, the size of solitary parathyroid gland was (3.93±0.67) cm3 which did not change significantly compared with that before treatment. The echogenicity of parathyroid glands enhanced and blood supply decreased after injection ethanol into solitary parathyroid. PTH [(509.2±27.6) ng/L] decreased obviously (t=3.792, P < 0.05). Conclusion Color Doppler ultrasound guided percutaneous injection of ethanol has an important role in the treating of secondary hyperparathyroidism and the curative effect can be observed timely.

Ductal strictures, recurrent cholangitis, liver atrophy or hepatic abscess, and ultimate cholangiocarcinoma are the major pathological entities of primary hepatolithiasis. Because of distinctive bile ductal lesion and hepatic tissue inflammation, liver resection indicated for hepatolithiasis should have different emphasis on perioperativer assessments and managements from hepatectomy for liver cnacer. Preoperative assessment should focus on the feasibility of precise hepatectomy for good long-term outcome. Percutaneous bile duct drainage is considered preferentially for patients with cholangitis. Attention should be paid to avoiding major blood loss, postoperative bile leakage and infectious biloma formation in surgical steps such as hepatic hilum dissection, liver parenchymal transection, bile duct exposure, bile duct stump closure and drainage of liver raw surface. The indication for biliary reconstruction should be based on the estimation of function of the Oddi sphincter. For residual hepatolithiasis, choledochoscopical trans-T tube stone withdraw should carried out 3 months postoperatively in prevention of laceration of T-tube fistula.

Objective To investigate the value of the diagnosis of contrast-enhanced ultrasound(CEUS) in renal tumors. Methods Nineteen patients with hyperechoic renal tumors detected by CEUS underwent resection for suspected renal malignant and benign tumors. The characterization of hyperechoic renal tumors on CEUS was evaluated. Results Histopathologic results of resected lesions showed benign tumors in 11 patients with angiomyolipoma and malignancy in 8 patients with clear cell carcinoma. Six patients with angiomyolipoma showed rapid wash in contrast enhancement and slow wash out on all tumor and focal tumor (6/11). One patient with angiomyolipoma was observed in rapid wash in and wash out (1/11). Four patients with angiomyolipoma showed rapid wash in and negative contrast enhancement after rapid wash out(negative contrast enhancement compared to renal cortex,4/11). Five patients with clear cell carcinoma showed rapid wash in and wash out (5/8). Two patients with clear cell carcinoma showed rapid wash in and delayed wash out (2/8). One patient with showed no enhancement on CEUS (1/8). The pseudocapsule could be seen at 5 patients with clear cell carcinoma. Wash in enhancement and wash out on clear cell carcinoma were significant in comparison to these of angiomyolipoma (P<0.05). Wash in enhancement,delayed wash out and negative contrast enhancement were no significant between clear cell carcinoma and angiomyolipoma (P>0.05). Conclusions CEUS is useful for discriminating between benign and malignant renal tumor.

Objective To study the formations of several ridges in peripheral artery velocity tracing. Methods The experimental models of constrainting limb and adrenaline were performed in 6 juvenile susscrota domesticas,tbe variations of the external lilac artery velocity tracing observed,and the parameters of peak systolic velocity (PSV), minimum post-systolic velocity (MPV), peak diastolic velocity(PDV) and end diastolic velocity(EDV) were obtained. Results With the increase of downstream circulation resistance, systolic waveshape inclined to acumination, MPV gradually degraded to zero and negatively increased subsequently, diastolic wave amplitude lowered, and EDV gradually decreased to zero. The stronger vasoconstriction was, the more striking the variations were. Conclusions Cardiac ejection forms systolic dominant wave, post-systolic backward ware is the result of backstreaming because of elastic recoil of downstream artery,and diastolic forward ware is the result of blood transient acceleration caused by elastic recoil of upstream artery. Systemic vascular resistance has significant effect on diastolic waveshape,and the occurrence of post-systolic backward ware implies downstream circulation resistance obviously increases.

Objective To study the haemodynamics changes in the proximal upstream artery caused by different degrees of abdominal aorta extremity stenosis.Methods The lateral walls of the abdominal aorta extremity were pinched with the vascular clamp to achieve 1/4,1/2 and 3/4 stenosis or occlusion in 6 juvenile susscrota domesticas,the velocity tracing of the proximal artery recorded,and the parameters of the peak systolic velocity(PSV)and minimum diastolic velocity(MDV)were obtained and statistically analyzed for their correlation with different degrees of abdominal aorta extremity stenosis.Results The diastolic velocity tracing vanished when stenosis reached a certain degree,the needle ridge and low amplitude diastolic velocity tracing emerged when stenosis to a certain extent,and only the needle ridge was present when the abdominal aorta extremity was completely obstructed.PSV reduced with the aggravation of stenosis.Conclusions The proximal upstream artery systolic ridge caused by abdominal aorta extremity stenosis tends to be acUminate,which indicates serious stenosis of the downstream artery.The systolic needle ridge and the absence of diastolic velocity tracing would suggest a complete obstruction of the blood stream in the downstream lumina.

Objective To assess the coronary flow reserve in the patients with systemic lupus erythematosus(SLE)by transthroracic echocardiography(TTE).Methods Coronary sinus blood flow of 24 SLE patients and 18 matched healthy controls were assessed by TTE.The coronary flow reserve was calculated as the ratio of hyperemic to baseline blood flow.Hyperemia was induced by intravenous administration of dipyridamole.Results Adequate recordings of blood flow in the coronary sinus under both conditions were obtained by TTE in all study subjects.Patients with SLE were found to have significantly decreased coronary flow reserve comparing with normal SUbiects(1.55±0.21 versus 2.51±0.33.P＜0.01).Conclusions Coronary flow reserve can be measured by TTE in SLE patients,Coronary flow reserve is impaired suggesting that SLE patients may have subclinical coronary artery disease.

Objective To assess the differential diagnosis and characteristics of renal benign and malignant tumors with three-dimensional contrast-enhanced ultrasound (3D-CEUS). Methods Totally 68 patients with renal tumors were examined by conventional ultrasound and two-dimensional contrastenhanced ultrasound(2D-CEUS). 3D imaging was reconstructed from 2D imaging, the differential diagnosis of renal tumors with 3D-CEUS was analyzed by comparing with 2D-CEUS. All patients with renal tumors were proved by operational pathology. Results Eighteen patients with renal benign tumors mostly displayed equal or low enhancement, showed "slowly in and slowly out" with 2D-CEUS, while displayed regular peripheral and internal vessels with 3D-CEUS. Fifty patients with renal malignant tumors mostly displayed high enhancement, showed "rapidly in and rapidly out" with 2D-CEUS,displayed winding peripheral vessels and disordered internal vessels with 3D-CEUS. 3D-CEUS may display the vascular characteristics of tumors and showed superior imaging quality to 2D-CEUS ( P ＜ 0.05). Conclusions 3D-CEUS can display the vascular characteristics of tumors and their spatial positions, it plays an important role in differential diagnosis between renal benign and malignant tumors.

Objective To explore the value of contrast-enhanced ultrasound(CEUS) in the diagnosis of hematoma and active hemorrhage of renal trauma. Methods Totally 28 patients with renal trauma were examined by conventional ultrasound and CEUS,respectively,including 24 cases caused after renal biopsy,4closed trauma. The detectability of renal hematoma and active hemorrhage with these two methods were compared. All patients were identified by CT or follow-up studies with ultrasound. Results The detectability of renal hematoma with conventional ultrasound and CEUS were 67. 86% (19/28), 92. 86%(26/28), respectively. There was statistically different for detectability in the diagnosis ( P ＜0.05), and the extent of hematoma was more obvious with CEUS. CEUS diagnosed 7 of 26 were renal hematoma with active hemorrhage,which were difficult to be detected with conventional ultrasound. For renal hematoma,the features of CEUS were no enhancement found in every phase; for renal hematoma with active hemorrhage,the contrast agents overflowed from injured blood vessels and formed irregular remarkable enhanced regions. Conclusions CEUS is useful in diagnosing hematoma and identifying the extent and active hemorrhage of renal trauma,in addition,CEUS is valuable in detecting complications after renal biopsy.

Objective To assess the efficacy of high intensity focused ultrasound (HIFU) for the ablation of feeding-artery in uterine fibroids.Methods A total of 45 women with uterine fibroids who had children accepted HIFU treatment.Color Doppler and contrast-enhanced ultrasound were used to target the supply vessels entered the fibroid.HIFU treatment was focused primarily on locations where supplying vessels entered the fibroid.Conventional ultrasound,color Doppler ultrasound,contrast-enhanced ultrasound and MRI were performed before and after HIFU treatment to observe the changes of imaging.Results After HIFU treatment,the volume of uterine fibroids decreased to certain extent.The blood signals decreased or disappeared in the treated regions.Bewteen two groups of the uterine fibroids diamete ≥5 cm and ＜5 cm,there were significant differences in the percentage of the nonperfusion regions in the volume of uterine fibroids (≥70％,P ＜0.05).Conclusions Ablation of feeding artery by HIFU is an effective treatment for the uterine fibroids.HIFU treatment is effective for the ablation of feeding-artery in uterine fibroids whose diameter less than 5 cm.