Objective Using coded harmonic angiography to observe hepatocellular carcinoma blood perfusion features,further assess this modality clinical value in qualitative diagnosis of liver malignant tumor.Methods Through left forearm vein bolus injection of fluorine-carbon contrast agent,35 patients with 41 hepatocellular carcinoma lesions were examined with coded harmonic angiography,intratumoral vessel enhanced time,vascularity,blood perfusion were observed.All patients were simultaneously videotaped before and after contrast.Results It was about 15～20 s after the injection of contrast agent when the enhancement of tumor had just commenced,peak time about 60～90 s and persistence time about 240～300 s.Lesions were more obviously enhanced than normal liver tissue,several tumor vascularity was displayed from border to center,contrast agent gradually centripetal filled-in,formed "weeping-willow" echo.Pressed and rimlike peripheral vessel developments were earlier than normal liver tissue.Conclusions Coded harmonic angiography could real-timely display hepatocellular carcinoma blood perfusion,which has an important clinical value in qualitative diagnosis of liver malignant tumor.

Objective To analyze the double contrast-enhanced ultrasonography (DCUS) features of periamupullary carcinoma for enhancing the ultrasound diagnostic value of the disease.Methods The DCUS and clinical data of 40 patients with periampullary carcinoma confirmed by histopathology were reviewed.Results (1) The displaying rate of the lesions and the judgment of lesion location was statistically higher on DCUS than that of ordinary ultrasound (P ＜ 0.05).(2) DCUS features of periampullary carcinoma:the size of most lesions was less than 30 mm except for 1 case in which no lesion was found; In 100％ (39/39) of the lesions,the morphology did not change with duodenum movement ; In 64.1％ (25/39) of lesions hyperenhancement or isoenhancement was displayed in the arterial phase,with low enhancement in the venous phase; In 87.2％ (34/39) of lesions homogeneous enhancement was displayed; In 95％ (38/40) the bile ducts were moderately or severely dilated.The lesion locations and whether the lesions projected into the duodenal cavity or not were statistically different between the three different types of periampullary carcinoma (P ＜ 0.05).The lesions projected into the duodenal cavity of duodenum were more commonly seen in papillary carcinoma and ampullary carcinoma than distal common bile duct carcinoma.The lesion size,whether the lesion morphology changed or not with duodenum movement,enhancement level,enhancement homogeneity,the degree of bile duct dilatation,whether there was pancreatic duct dilatation or not were not statistically different between the three different types of periampullay carcinoma (P ＞ 0.05).Conclusions DCUS is an effective way to show periampullay carcinoma,and is helpful to diagnose periampullary carcinoma and distinguish the three different types of periampullary carcinoma.

Objective To evaluate the clinical value of artificial pleural effusion for percutaneous microwave ablation of liver cancer in the hepatic dome. Methods 28 difficult cases (total 34 lesions), all lesions were located in the hepatic dome and covered by lung. Infused with artificial pleural effusion by ultrasound real-time monitoring before percutaneous ultrasound-guided microwave ablation. The amount of artificial pleural effusion, the technique successful rate,the rate of lesions revealed, local treatment response and complications had been observed. Results The amount of artificial pleural effusionwas 200-1 000 mL [(388 ± 107)mL]. The technique successul rate of artificial pleural effusion was 100% (28 / 28), the rate of lesions revealed was 85.3%(29 / 34), the other 5 isoechoic lesions were revealed by contrast-enhanced ultrasound. All the 34 lesions was ablated completely, the complete ablation rate was 100%(34 / 34). the rate of complications was 2.9%(1 / 34), 1 patient was found a small amount of intraperitoneal hemorrhage after ablation. Conclusions Artificial pleural effusion assisted percutaneous microwave ablation of liver cancer in the hepatic dome is a safe , effective treatment, it broadened the percutaneous microwave ablation therapeutic range, and should be more widely used in clinically.

Objective To analyze the reasons of focal liver lesions that difficult to detect by conventional ultrasound ultrasound-CT/MR fusion imaging.Methods 101 lesions which were confirmed by pathology or clinical diagnosis standards were recruited in the research.All of them were difficult to detect by conventional ultrasound but CT/MR display clearly.Ultrasound-CT/MR fusion imaging was used to observe the size,location and internal echo of the lesions,as well as the background of the surrounding liver parenchyma.Results All cases were successfully registrated,the registration time were 2-6min [(4.1 ±0.6)min].For these 101 lesions,93.1％(94/101) of which the diameter ≤20 mm,56.4％ (57/101) were located in hepatic segments near the diaphragm (such as S2,S4,S7,S8),78.2％ (79/101) were internal isoecho,and 79.2％(80/101) in the background of liver cirrhosis.Conclusions The important reasons that focal liver lesions detected difficult by conventional ultrasound includes:lesion size,location,internal echo and the hepatic background.

Objective To explore the feasibility of evaluation of hepatic fibrosis using the tissue dispersion quantitative analysis software based on ultrasonic elastography. Methods Forty-six chronic liver disease patients were examined by tissue dispersion quantitative analysis software. There were 11 characteristic quantities of elastography imaging obtained by the tissue dispersion quantitative analysis software,including average relative strain value,standard deviation of relative strain value,area ratio of low-strain region ( AREA%) , complexity, kurtosis, skewness, contrast, entropy, inverse different moment,angular second moment,correlation. The 11 characteristic quantities were compared with pathological stages of hepatic fibrosis. Results The characteristic quantities had statistically significant differences except kurtosis and correlation in the analysis of variance and correlational study with pathological stages ( P < 0.05). The AREA% had the highest related coefficient ( r = 0.725). The ROC curve was made by AREA% ,the areas under the ROC curve were 0. 865 ,0. 880 and 0. 886. Conclusions The tissue dispersion quantitative analysis software is helpful in the evaluation of stages of hepatic fibrosis. The AREA% has the highest relationship with pathological stages of hepatic fibrosis and good diagnostic value.

Objective To evaluate the feasibility and accuracy of three-dimensional ultrasound (3DUS) automatic image fusion based on hepatic vessel in clinical application.Methods Forty pairs of 3D ultrasound volumetric images from 10 healthy volunteers were acquired and enrolled in the study,including 10 pairs of each following lobe of the liver:left lateral lobe,left medial lobe,right anterior lobe and right posterior lobe.3DUS automatic registrations were performed based on hepatic vessel.The technical successful rate and accuracy of the image fusion using the 3DUS data from four hepatic lobes were observed and compared.Results Thirty-six pairs of volumetric data were successfully fused together by automatic registration.The technical successful rate was 90％ (36/40) and the registration error distance was 1.48 mm (0.98-2.76 mm).There were no statistical differences in the successful rate for the four different hepatic lobes (P =0.891),but the registration error of right anterior lobe was less than left lateral lobe of liver (P =0.014).Conclusions The new technology of 3DUS automatic registration based on hepatic vessel was feasible and reliable,and it has a wide prospect in future clinical application.

Objective To discusse the feasibility and application value of the computer-assisted liver cancer ablation planning based on the three dimensional ultrasound.Methods Forty three-dimensional ultrasound images of 39 patients with 40 tumors'maximum diameter between 21 to 70 mm were collected and then acquired image segmentation and visualzation.The computer-assisted liver cancer ablation planning based on three dimensional ultrasound was comparied with the artificial ablation planning based on two dimensional ultrasound to find out the differences in the success rate,damage rate,time-consuming and the number of insertions between these two methods.Results Compared with the artificial ablation planning based on two dimensional ultrasound,the computer-assisted liver cancer ablation planning had a higher success rate(92.31% vs 53.85%,P =0.000),lower damage rate(7.50% vs 25.00%,P =0.034),shorter time-consuming(44.0 s vs 263.0 s,P =0.000)and less insersion times(3 vs 4,P =0.009).Conclusions The computer-assisted liver cancer ablation planning based on three dimensional ultrasound is more efficient and safety than the traditional way.

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.

Objective To evaluate the feasibility and accuracy of three-dimensional ultrasound-ultrasound (3DUS-US)automatic image fusion technology based on electromagnetic positioning.Methods The experimental phantom was constructed to acquire ultrasonic images by agarose gel and additives,which was used as the experimental object.3DUS imaging with free-hand and real-time ultrasound imaging automatic registrations were performed based on electromagnetic positioning.To investigate the effect of 3DUS-US image fusion under different scanning speed by free-hand,the fast and slow groups were designed. In addition,a junior operator and a senior operator performed 3DUS-US automatic registrations,and recorded the operating time and registration error,respectively.The repeatability between two operators was analyzed.Results The macroscopic appearance,stability and ultrasonic image of the phantom met the demand of this research.The success rate of 3DUS-US automatic image fusion technology was 100%(40/40).The slow group's registration error distance was (1 .44 ± 0.64)mm,which was obviously lower than the fast group's (2.56±0.53)mm,the difference was statistically significant (P <0.001).There were no statistically differences of the registration error and operating time between the two operators (P =0.508,P = 0.5 1 7 ).Conclusions The technology of 3DUS-US automatic registration based on electromagnetic positioning was feasible and accurate,which is worth applying into the clinical treatment.

Objective To evaluate the clinical value of CT/MR-contrast enhanced ultrasound (CEUS) image fusion in immediate assessment for hepatocellular carcinoma (HCC)ablation.Methods Patients diagnosed with HCC to receive ablation therapy were randomly divided into two groups.The ablation for each patient was performed according to their pre-ablation plan.Immediate assessments for the ablation were performed using CT/MR-CEUS image fusion (IF group)and CEUS (CEUS group)separately and whether the need for additional ablations was decided and performed during the therapy.The therapy efficacy was evaluated with enhanced CT or MR 1 month after each complete ablation treatment.Results There were 101 patients with 131 nodules in IF group,and 15.1% of the nodules needed additional ablation according the immediate assessment during the therapy.The complete ablation rate of IF group was 99.2%(125/126).On the other hand,there were 93 patients with 122 nodules in CEUS group,and 4.2% of the nodules needed additional ablation according the immediate assessment during the therapy.The complete ablation rate of CEUS group was 94.2% (113/120).IF group has significantly higher additional ablation rate and complete ablation rate than CEUS group (P <0.05).Conclusions CT/MR-CEUS image fusion can further improve ablation efficacy with accurate intraoperative evaluation and guidance of additional ablation compared with CEUS.