Objective To assess the applicability of sound touch elastography ( ST E) and sound touch quantify ( ST Q ) in measuring liver and spleen stiffness . Methods One hundred and eighteen healthy volunteers were included and underwent ST E and ST Q . T he success rate ,variability and reproducibility of ST E and ST Q were analyzed . T he accurate sampling size and number of tests for liver ST Q were also analyzed . Results T he success rates ,variability ,reproducibility of ST E and ST Q in liver were 97 .5% and 99 .2% ,8 .7% and 12 .0% ,0 .917 and 0 .916 , respectively . While those with spleen were 76 .3% and 66 .9% ,12 .4% and 16 .4% ,0 .847 and 0 .706 ,respectively . The sampling size of 1 .5 cm×1 .0 cm yield the lowest variability ( 8 .5% ) ( F ＝6 .562 , P ＝0 .002) ,and there was no significant difference between results of detecting 5 times and 10 times( P ＝0 .571) . T he liver and spleen stiffness of ST E were 5 .75 kPa ( 95%CI :5 .60－5 .91 kPa) and 15 .58 kPa ( 95% CI :14 .99 －16 .16 kPa) . Conclusions The measurement of liver stiffness using both ST E and ST Q have a high success rate and low variability . However ,ST E is better than STQ in measuring spleen stiffness .

Objective To explore the feasibility and convenience of automatic registration ultrasound-CT/MR fusion imaging based on hepatic vessel trees. Methods The PercuNav fusion imaging system of Philips Epiq 7 was used to perform ultrasound-CT/MR fusion imaging on 22 patients with focal liver lesions detected by contrast-enhanced CT or MR.Both automatic registration ultrasound-CT/MR fusion imaging based on hepatic vessel trees and the conventional ultrasound-CT/MR fusion imaging based on internal anatomic landmarks were employed for alignment in these patients.The results including the success rate of registration,duration time of initial registration,error of initial registration,number of times of fine-tuning, duration time of fine-tuning and the overall duration time of registration were compared between these two methods.Results The success rates of registration,duration time of initial registration,errors of initial registration,numbers of times of fine-tuning,duration time of fine-tuning and the overall duration time of registration for automatic registration ultrasound-CT/MR fusion imaging based on hepatic vessel trees and the conventional ultrasound-CT/MR fusion imaging based on internal anatomic landmarks were 72.73% and 95.45%,16.5 s (10~30 s) and 13 s (8~24 s),3 mm (1~14 mm) and 14 mm (2~43 mm),0 time (0 to 2 times) and 1 time (0~3 times),0 s(0~46 s) and 30 s (0~88 s),and 20 s (12~61 s) and 42 s (9~102 s),successively and respectively. There was no statistically significant difference in the success rates between these two methods ( P >0.05).The duration time of initial registration of conventional method was less than that of automatic registration method( P <0.05).The error of initial registration,number of times of fine-tuning,duration time of fine-tuning and the overall duration time of registration of automatic registration method were superior to those of conventional method ( P < 0.05).Conclusions Automatic registration ultrasound-CT/MR fusion imaging based on hepatic vessel trees is feasible. It is also more convenient than conventional ultrasound-CT/MR fusion imaging based on internal anatomic landmarks.

Objective To explore the value of contrast-enhanced ultrasonography (CEUS) in the screening of malignant transformation from cirrhotic nodules.Methods Clinical data of 25 patients who were followed up by ultrasonography in the Third Affiliated Hospital of Sun Yat-sen University from January 2012 to December 2016 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients were males, aged 33-82 years old, with the median age of 55 years old, and with a total of 29 cirrhotic nodules. All patients were followed up regularly by ultrasonography which included conventional ultrasound and CEUS. The diameter, internal blood flow signal and CEUS features of the nodules were recorded. The diameter was compared by t test, and the CEUS features by Fisher's exact probability test. ROC curve was used for diagnostic test.Results During the follow-up, 14 cirrhotic nodules turned into hepatocellular carcinoma (HCC). The diameter of malignant nodule (19± 8) mm was significantly higher than (16±7) mm before malignant change (t=2.682, P<0.05). As the nodules transformed to malignancy, in the arterial phase of CEUS, signals changed gradually from equal enhancement (12/14) to hyper enhancement (13/14), and in the portal venous phase or delayed phase, it changed from equal enhancement (13/14) to low enhancement (13/14), where significant difference was observed (P<0.05). The area under the curve of AFP, conventional ultrasound and CEUS in diagnosing malignancy of cirrhotic nodules was 0.607, 0.679 and 1, respectively, where significant differences were observed (Z=4.837, 6.904, P<0.05).Conclusion In the continuous follow-up of cirrhotic nodules, CEUS can detect the hemodynamic changes in malignant nodules early, which has better diagnostic value than conventional ultrasound.

Objective To investigate the safety and efficacy of ultrasound-guided thermal ablation in the treatment of rare liver tumors.Methods Clinical data of 9 patients with rare liver tumors who underwent ultrasound-guided thermal ablation from January 2012 to December 2016 in the Third Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among 9 cases (14 lesions),2 patients were male and 7 female,aged (42±12) years on average.All the patients underwent ultrasound or contrast-enhanced ultrasound-guided puncture and thermal ablation of the tumors.The ablation effect was evaluated immediately by contrast-enhanced ultrasound during the operation.The incidence of postoperative complications was observed.The complete ablation rate was evaluated by CT or MRI at postoperative 1 month.Results 11 lesions were treated with common ultrasound-guided thermal ablation and 3 lesions with contrast-enhanced ultrasound-guided ablation.The intraoperative complete ablation rate was 100％ (14/14),and the rate at postoperative 1 month was also 100％ (14/14).No ablation related complications was observed.During the follow-up,no local tumor progression or intrahepatic and extrahepatic tumors recurrence was observed in all patients.Conclusions For rare liver tumors,ultrasound-guided thermal ablation can achieve the effect of complete ablation,providing a new therapeutic option for the patients.

Objective To investigate the effect of bronchofibroscopic bronchoalveolar lavage on serum inflammatory cytokines in the patients with severe ventilator-associated pneumonia(VAP) .Methods 68 cases of severe VAP were divided into the control group and observation group according to the random number table method ,34 cases in each group .The control group used conventional alveolar lavage plus sputum suction treatment ,while the observation group adopted bronchofibroscopic bronchoalveolar lavage plus sputum suction treatment .The lung infection control time ,mechanical ventilation treatment time ,time of body temperature recovery to normal ,pulmonary infection score(CPIS) ,white blood cell(WBC) count ,respiratory function ,blood gas indexes and serum inflammatory factors levels were compared between the two groups .Results The lung infection control time ,mechanical ventilation treatment time ,recovery time of normal temperature ,blood gas indexes and serum inflammatory factors levels after treatment in the observation group were significantly superior to those in the control group (P＜0 .05) .Conclusion Bronchofibroscopic bronchoalveolar lavage can significantly improve the respiratory function and blood gas indexes ,reduces the serum inflammatory factors levels in the patients with severe VAP .

Objective To analyze the optimal threshold of Doppler ultrasonography(DUS)in the diagnosis of hepatic artery stenosis(HAS)after liver transplantation and propose the diagnostic criteria of CT angiography(CTA) or digital subtraction angiography(DSA)for patients with tardus parvus waveform(TPW)in combination with liver dysfunction. Methods Clinical data of 171 patients undergoing liver transplantation, postoperative conventional DUS, liver function test, CTA or DSA were collected. The optimal threshold of resistance index(RI)and systolic acceleration time (SAT)for the diagnosis of HAS were determined by multi-level likelihood ratio(MLR). Different diagnostic criteria were established and the diagnostic efficacy was statistical y compared. Positive TPW was defined as the diagnostic criterion with low confidence, positive TPW+liver dysfunction as the moderate confidences, and positive TPW+liver dysfunction or positive TPW+optimal threshold as the high confidence. Results MLR revealed that RI<0.4 and SAT>0.12 s were the optimal threshold for the diagnosis of HAS. The specificity of diagnostic criteria with moderate and high confidence was significantly higher compared with that of the low confidence(P<0.05). Moreover, the false-positive rate was significantly decreased(P<0.05). The sensitivity of diagnostic criterion with moderate confidence was significantly lower than those of low and high confidence(both P<0.05), whereas the sensitivity did not significantly differ between the diagnostic criteria with low and high confidence(P>0.05). Conclusions For patients with positive TPW detected by DUS after liver transplantation, the optimal threshold of diagnostic criteria combined with liver dysfunction contribute to appropriate clinical decision-making for clinicians.

Objective To evaluate the feasibility,efficacy and tolerability of ultrasound-guided percutaneous radiofrequency ablation(RFA) for treating malignant tumor in the caudate lobe.Methods A retrospective analysis was performed in the patients with malignant tumor in the caudate lobe treated by percutaneous radiofrequency ablation (RFA) from January 2009 to July 2016.The epigastric approach (EA),the intercostal approach (IA) and an approach combining EA and IA were used as the paths of puncture.Intraprocedural contrast enhanced ultrasound (CEUS) was used to evaluate the ablation effect.The enhancement of CT/MR was used as the gold standard to evaluate the ablation effect within 1 to 3 months after surgery.Technical success (TS),technique efficacy (TE),local tumor progression (LTP) and complications were documented.Results A total of 14 patients with 14 malignant tumors in the caudate lobe of the liver were included in this study.The EA,IA,and the approach combining EA and IA were used in 7,6,and 1 patient,respectively.Intraprocedural CEUS showed complete ablation in all cases.CT / MRI evaluation within 1 to 3 months after surgery showed that the complete ablation rate was 100％ (14/14).After a median follow-up of 15.5 months (interquartile range,3 55 months),2 patients had recurrence in other regions of the liver,there was no local tumor progression and no serious complications occurred in 14 patients.Conclusions Ultrasound guided RFA is a safe,effective and important mean for the treatment of malignant tumors in caudate lobe of liver.

[Objective]To evaluate the two-dimensional shear wave elastography(2D SWE)in predicting the prognosis of the patients with acute-on-chronic hepatitis B liver failure(ACLF-HBV).[Methods]312 patients diagnosed with ACLF-HBV at the De-partment of Infectious Diseases in the Third Affiliated Hospital of Sun Yat-sen University from October 1st 2013 to December 31th 2015 were recruited. The baseline data of all patients,including 2D SWE,laboratory data,ultrasonographic data,Model for End-stage Liver Disease score(MELD),Child-Turcotte-Pugh score(CTP),and King′s College Hospital score(KCH),were collected when enrolled. All patients were followed up for at least 90 days and their clinical outcomes(recovering or worsening)were recorded. 2D SWE values of all patients were dynamically collected every 2~4 weeks during the follow-up until death,liver transplantation, or discharging from hospital.[Results]The worsening patients showed higher 2D SWE values than the recovering ones[(44.0 ± 7.5) kPa vs(36.8 ± 10.3)kPa,t=-6.5,P=0.000],2D SWE value less than 39.2 kPa could be a prediction of the patient′s recovery in 90 days.The predictive value of 2D SWE(AUROC=0.73)was higher than that of KCH(AUROC:0.65,z=2.1,P=0.033). Among all the dynamically measured patients,2D SWE rose from(42.1 ± 8.0)kPa to(47.5 ± 9.3)kPa in the worsening group during the 90-day follow-up,while nearly stable in the recovery group.[Conclusion]Noninvasive liver stiffness measurement by 2D SWE is a use-ful method in evaluating the prognosis of ACLF-HBV patients. Taking a cutoff of 39.2 kPa,patients with higher 2D SWE values could have worse clinical outcomes ,otherwise better. It seems that dynamically measuring 2D SWE values could also be helpful ,but more research in the future should be needed.

Objective To investigate the therapeutic effect of high intensity focused ultrasound (HIFU) ablation combined with homemade liquid fluorocarbon nanoparticles on cervical cancer in nude mice.Methods The cell experiment was divided into three groups:a,control group;b,HIFU group;c, HIFU + PFB nanoparticle group,and the viability of cells was detected using CCK-8 reagent.The mice were also divided into three groups:A,0.9% NaCI group;B,HIFU + 0.9% NaCI group;C,HIFU + PFB nanoparticle group. The tumors were removed and underwent triphenyl tetrazolium chloride(TTC) staining,and the necrosis area was measured.Histopathological changes of the tumors were examined by light microscopy.Results After HIFU irradiation,the viability rate of group c was (40.5 ±9.7)%,it was lower than that of group b (77.7 ±8.5)% (P <0.05) and that of group a(100 ±4.8)% (P <0.05). TTC staining of tumor showed a large scale of necrotic tissue in group C.The necrosis ratio of the three groups was 0%,(34.14±12.2)% and (65.97 ±25.1)%,respectively (P <0.05).HE staining showed karyorrhexis or an absence of nuclei in group B and group C,which demonstrated the coagulation necrosis. Conclusions HIFU ablation combined with liquid fluorocarbon nanoparticles can effectively treat the xenograft model of the human cervical carcinoma in nude mice.

Objective To compare the value of acoustic structure quantification(ASQ) and shear wave elastography(SWE) in the evaluation of diagnostic accuracy of liver fibrosis.Methods One hundred and thirty-five patients with chronic hepatic diseases enrolled in our study were underwent ASQ,SWE and liver biopsy.Correlation between Total Mode,BR ratio,the elastic modulus and pathological stages of liver fibrosis were analyzed by Spearman's rank test.ROC curves were set up by evaluating the degree of hepatic fibrosis through Total Mode,BR ratio,the elastic modulus.Results The significant positive correlation were observed between Total Mode,BR ratio,the elastic modulus and pathological stages of liver fibrosis(r =0.46,P =0.000; r =0.49,P =0.000; r =0.68,P =0.000,respectively).Total Mode,BR ratio,and the elastic modulus,of each pathological stages,had statistically significant differences (F =6.05,P =0.000 ; F =5.17,P =0.000; F =48.82,P =0.000,respectively).The areas under the ROC curve (AUC) set up by evaluating the pathological stages of fibrosis (S≥ 1,S≥2,S≥3 and S =4) through the elastic modulus were larger than that of Total Mode and BR ratio(all P ＜0.05).But the AUC for the diagnosis of fibrosis of Total Mode and BR ratio showed no statistically significant differences(all P ＞0.05).Conclusions SWE was more accurate than ASQ parameters (Total Mode,BR ratio) in grading hepatic fibrosis.ASQ parameters (Total Mode,BR ratio) were observed well-correlated with the pathological staging of hepatic fibrosis.