Objective:To investigate the application value of shear wave elastography (SWE) in the evaluation of T re-staging after neoadjuvant chemoradiotherapy (nCRT) for locally advanced rectal cancer.Methods:Clinical, endorectal ultrasound (ERUS) and SWE data of 271 patients with locally advanced rectal cancer who underwent nCRT and total mesorectal excision in Fujian Medical University Union Hospital from October 2021 to March 2023 were prospectively collected. The independent predictors for low T staging were analyzed and screened, and the Logistic regression model was constructed. An independent test set was used to validate the prediction performance of the models and compare them with the diagnostic results of sonographers.Results:Binary multivariate Logistic regression analysis showed that Emean of the mesentery around the lesion, thickness, and enlarged lymph nodes around the rectum were the independent predictors for low T staging, and the odds ratios were 1.089, 1.214, 0.183, respectively. The Logistic regression model A established by Emean, thickness and enlarged lymph nodes around the lesion and the Logistic regression model B established by Emean around the lesion had high diagnostic efficiencies (area under the ROC curve were 0.931, 0.918, respectively, the accuracy were 0.888 and 0.887, respectively). There was no significant difference in diagnostic accuracy between the two models ( P=1.000), and both models were significantly higher than that of sonographers (all P<0.001). Conclusions:SWE can effectively predict whether the tumor is of low T staging after nCRT in locally advanced rectal cancer, and can be used as an important supplement to ERUS in evaluating the T re-staging of rectal cancer after nCRT.

Objective:To evaluate the value of contrast-enhanced ultrasound (CEUS) in the diagnosis and differential diagnosis of bladder urothelial carcinoma(BUC).Methods:A comparative analysis of 138 patients with bladder lesions (123 cases of BUC and 15 cases of other benign lesions) who were hospitalized in Union Hospital, Fujian Medical University from January 2019 to May 2021 were confirmed by pathology. All patients underwent two-dimensional ultrasound, color Doppler ultrasound, CEUS examination, the time intensity curve (TIC) of the region of interest(ROI) before operation was drawn, the ultrasound examination results with the pathological diagnosis results were compared and its diagnostic efficiency was analyzed.Results:Among the 138 cases of bladder lesions, 98 cases were single lesions and 40 cases were multiple lesions. In all single lesions, 95 cases were found by two-dimensional ultrasound and 3 cases were missed, while in all multiple lesions, 24 cases were found by two-dimensional ultrasound and 16 cases were missed, but all cases could be shown by CEUS. The sensitivity of CEUS to multiple bladder lesions was higher than that of two-dimensional ultrasound ( P<0.05). Besides, the differences between BUC and benign lesions in color blood flow distribution intensity and CEUS performance were significant (both P<0.05). Malignant lesions were mostly "less- to -rich" blood flow signals, and benign lesions were mainly "less- to- no" blood flow signals.In addition, in the CEUS examination, 83.7% (103/123) of BUC were high enhancement, and only 33.3% (5/15) of benign lesions were high enhancement. The diagnostic accuracy, specificity and negative predictive value of CEUS(89.9%, 46.7%, 53.8%) were higher than that of two-dimensional ultrasound(67.4%, 13.3%, 13.3%). The area under the curve, the rising slope and the peak intensity of BUC were all higher than those of benign lesions, and the differences were significant(all P<0.05), but none of them was independent risk factor for BUC ( P>0.05). Conclusions:CEUS can significantly improve the diagnostic sensitivity of bladder multiple lesions and help to improve the diagnostic accuracy of BUC, while the area under the curve, the rising slope and the peak intensity of TIC were not the independent risk factors for BUC.

Objective:To construct preliminarily the malignant risk classification system for the cervical lymph node.Methods:A total of 301 patients with cervical lymphadenopathy were collected in this prospective study from Union Hospital, Fujian Medical University from July 2018 to December 2019. The ultrasonographic features(including the short diameter, ratio of long to short diameters(L/S), margin, border, matting, echogenic hilum, echogenicity, gross necrosis, microcalcification, hyperechoic area, flow type, vascular distribution), history of malignancy, inflammation performance of the neck and history of tuberculosis were analyzed. A score was assigned for each significant index related to benign/malignant lymph nodes by a Logistic regression analysis. The classification of the malignant risk was determined on the basis of the scores.Results:The factors significantly associated with the malignant lymph nodes were enlargement of the short diameter, L/S<2, microcalcification, hyperechoic area, irregular margin, matting, abnormal flow pattern, malignancy history. While the factors related to the benign were the inflammation performance and the fuzzy boundary. The risk of malignancy increased as the score of lymph node increased. The malignant risk of lymph node according to the classification system was as follows: category 1, 7.30%; category 2a, 35.00%; category 2b, 69.30%; category 2c, 91.50%; and category 3, 99.05%. The area under the ROC curve of the system was 0.913.Conclusions:The system has great potential of clinical application to assess the risk of malignancy in cervical lymph nodes.

Objective:To investigate the feasibility of shear wave elastography (SWE) to evaluate the protective effect of testicular compartment decompression on spermatogenesis after testicular torsion reduction.Methods:Thirty-two rabbits were randomly divided into 4 groups: control group (S group), testicular torsion simple reduction group (I group), and testicular torsion reduction+ compartment decompression group (T group: T1 group, T2 group), 8 rabbits per group. After the complete testicular torsion model was established in the I and T groups, the I group was simply reperfused, and the T group was reperfused before decompression of the compartment. Rabbits in each group were kept for 30 days after successful modeling. Each group of rabbits underwent testicular fascia intracompartment pressure measurement and SWE examination before operation, after successful complete torsion modeling, after reperfusion and 30 days later. After the experiment, the surgical side testicles were taken for pathological examination.Results:After testicular torsion, the pressure of testicular fascia and the average Young′s modulus (Emean) of testicular tissue in each experimental group increased (all P<0.05), and further increased with the extension of torsion time (all P<0.05). After reperfusion, the testicular fascial compartment pressure and testicular tissue Emean value in group I further increased (all P<0.05), while the testicular fascial compartment pressure and testicular tissue Emean value in group T decreased (all P<0.05). Thirty days later, testicular fascial compartment pressure and testicular tissue Emean value in group I were higher than those in group T (all P<0.05), while Johnsen′s score of testicular tissue was lower than that in group T ( P<0.05), and testicular tissue apoptosis index and malondialdehyde content were higher than those in group T Group T (all P<0.05). Conclusions:Decompression of the testicular compartment has a protective effect on spermatogenesis after testicular torsion reduction. SWE can indirectly evaluate the severity of testicular compartment syndrome after testicular torsion and reduction, and the protective effect of compartment decompression on spermatogenesis.

Objective:To investigate the value of three-dimensional transvaginal sonography(3D-TVS) in the diagnosis of intrauterine adhesions(IUA) and to analyze the causes of the missed diagnosis.Methods:Forty-seven patients with IUA were examined by three-dimensional transvaginal sonography(3D-TVS), 3D volume imaging (Render imaging) and tomographic ultrasound imaging(TUI imaging) in the Union Hospital of Fujian Medical University from January 2017 to July 2019. The abnormal echo data of the endometrium were recorded and analyzed, and the ultrasound diagnosis and hysteroscopic diagnosis were compared.Results:3D-TVS correctly diagnosed IUA was accurate in the 39 cases whose ultrasound imaging showed an uneven thickness of endometrial echo with the uterine cavity line having different degrees of echo continuity interruption. The diagnostic accuracy rate was 83.0%(39/47). In the Render imaging, 7 cases showed endometrial echo with honeycomb change, 28 cases showed partial echo loss with irregular low echo zone or low echo, and 4 cases showed corneal disappearance of one side. In TUI imaging, the endometrium was partly thinned in varying degrees where echo continuity was interrupted with hypoechoic band-like changes in all 39 cases. Three of the 8 missed IUA cases showed slender endometrium with filiform or membranous adhesions, and the other 5 were patients with uterine endometrial polyps.Conclusions:3D-TVS, Render imaging and TUI imaging technology can display stereo images, which contributes to the better preoperative diagnosis and postoperative follow-up. Care should be taken to avoid missed diagnosis and to improve the diagnostic accuracy for IUA by the techniques.

Objective:To investigate the value of real-time shear wave elastography (SWE) in the diagnosis of acute testicular torsion.Methods:A total of 30 rabbits were randomly divided into 3 groups including control group (Group S), complete torsion group (Group C) and incomplete torsion group (Group U), and corresponding animal models were built. Rabbits in each group were examined by gray scale and color Doppler ultrasound, SWE and contrast-enhanced ultrasound(CEUS) before and after operation. Mean values of elasticity modulus (Emean) of testicular capsule area, parenehyma testis, spermatic cord torsion section, torsion lower section and contrast-enhanced ultrasound parameters were recorded and then pathological examinations were performed.Results:There was no significant difference for Emean values of each group in all parts before operation( P>0.05). There was no significant difference for Emean value of S group at each period after operation( P>0.05). Emean value of postoperative testicular capsule area in U group increased obviously and rapidly compared with C group, yellow or red "hard ring signs" appeared within four to six hours after operation, there was significant difference of Emean value difference at various periods after operation in group U and C, and at 1 h, 1.5 h, 2 h, 2.5 h, 3 h and 3.5 h postoperatively between group U and C( P<0.05). Postoperative Emean value of parenchyma testis in group C and U increased about 5 kPa, expression of SWE was consistent blue. Postoperative Emean value of spermatic cord torsion section in group C increased more obviously compared with U group, a large patch of red signals appeared within five to six hours after operation, there was significant difference of Emean value at various periods after operation in group C and U, and at each period except instant, 2 h, and 3 h postoperatively between group C and U( P<0.05). Postoperative Emean value in spermatic cord torsion lower section in group U and C increased slowly ( P<0.05), expression of SWE changed from blue to blue green and green from original blue. CEUS showed blood pefusion in testis was "in and out slowly " in group U, pathological feature showed the testicular spermatogenic cells were in disorder with interstitial edema, distinct expansion of microvascular lumen, hyperemia and congestion and lots of erythrocyte leakage. CEUS showed postoperative contrast agent was not filling in testicular in group C, pathological feature showed the testicular spermatogenic cells were in disorder with interstitial edema, slight expansion of microvascular lumen, congestion and part erythrocyte leakage. Conclusions:The image changes of SWE after acute testicular torsion are related with the degree and time of torsion, the changes of testicular capsule area and spermatic cord torsion section are most significant. The use of SWE helps to get accurate hardness information of focus with effective clinical value for the diagnosis testicular torsion.

Objective:To investigate the diagnostic value of multimodal transvaginal contrast-enhanced ultrasound combined with fallopian tubal patency.Methods:From November 2017 to November 2019, 212 patients with infertility were treated in the outpatient clinic of the Union Hospital of Fujian Medical University. Multimodal contrast-enhanced ultrasonography was used to analyze the diagnostic efficiency differences of four-dimensional transvaginal contrast-enhanced hysterosalpinx (TVS 4D-HyCoSy, 4D), three-dimensional contrast-enhanced hysterosalpingography (TVS 3D-HyCoSy 3D), two-dimensional contrast-enhanced hysterosalpingography (TVS 2D-HyCoSy 2D), and transvaginal harmonic imaging (TVS harmonic imaging, HI) individually and in different combinations. The diagnostic efficiency of tubal patency was compared between the high seniority group and the low seniority group.Results:Two patients gave up the examination because of pain. A total of 420 salpingography in 210 patients were successful, of which 375 were unobstructed and 45 were blocked (13 on the right, 18 on the left, and 7 on both sides). In high seniority group and low seniority group, the diagnostic efficiencies of different mode combinations on fallopian tubal patency were significantly different ( P<0.01). There were significant differences( P<0.05) between 4D+ 3D+ 2D+ HI group and 4D+ 3D+ 2D group, 4D+ 3D+ 2D group and 4D+ 3D group, 4D+ 3D group and 4D group. There was no significant difference ( P>0.05) in the diagnostic efficiency of fallopian tubal patency between high seniority group and low seniority group. Conclusions:The diagnostic efficiency of multimodal transvaginal contrast-enhanced ultrasound combined is higher than that of single mode, and ultrasound doctors in both high and low seniority groups can effectively diagnose fallopian tubal patency, which has important clinical value in the diagnosis of fallopian tube patency.

Objective:To explore the value of contrast-enhanced ultrasound and its quantitative analysis technology in the evaluation of testicular microvascular injury caused by chronic alcoholism, as well as its relationship with the morphological changes of testicular spermatogenic cells.Methods:Seventy-two New Zealand white rabbits were randomly divided into control group (S group), low-dose alcohol group (L group), medium-dose alcohol group (M group), and high-dose alcohol group (H group). Then, the rabbits were subdivided into the groups of S1, S2, S3, L1, L2, L3, M1, M2, M3, H1, H2, H3 according to different time points (30 d, 60 d, 90 d). The rabbits in each group were examined by routine ultrasound before the experiment, followed by contrast-enhanced ultrasound examination. Testicular tissues were taken for pathological examination under light and electron microscope.Results:①The peak intensity and area under the curve of ultrasound contrast parameters gradually decreased with the increase of dosage and duration of alcohol feeding (all P<0.05), and the curvature also gradually decreased (all P<0.05). The differences of peak time, mean transit time, and peak half-time were not statistically significant (all P>0.05). ②With the increase of alcohol dosage and duration under the light microscope, the seminiferous tubule epithelium gradually became thinner, and the sperm in the cavity gradually decreased or no sperm was produced. The Johnsen′s score of testicular tissue decreased with the increase of alcohol dosage and duration (all P<0.05). The cytoplasmic mitochondria of the microvascular endothelial cells were vacuolated under the electron microscope. With the dosage and duration of alcohol feeding, the endothelial cells were vacuolated and even shed, and the basement membrane was interrupted. Conclusions:Alcohol could damage the testicular microvessels and spermatogenic cells in a dose-effect and time-effect relationship. Contrast-enhanced ultrasound can be used to evaluate the microvessel damage of testis caused by chronic alcoholism and indirectly reflect the morphological changes of spermatogenic cells.

Objective: To investigate the value of transrectal ultrasonography(TRUS) in the preoperative diagnosis and tumor T-staging of anorectal malignant melanoma(ARMM). Methods: The clinical and ultrasound data of 19 patients(22 lesions) with ARMM confirmed by pathology from February 2008 to Apirl 2019 in Fujian Medical University Affiliated Union Hospital were collected. TRUS was performed within one week before pathological examination. The sonographic features were summarized, ultrasonic typing was performed according to the lesion size and growth pattern, and the accuracies of preoperative ultrasound diagnosis and tumor staging were analyzed. Results: Among the 22 lesions, 63.64%(14/22) were with a distance of ≤3 cm between the anal verge and the lower margin of tumor, 68.18%(15/22) with regular shape, 81.82%(18/22) with clear boundary, and 63.64%(14/22) with Adler blood flow grading from Ⅱ to Ⅲ. The preoperative TRUS diagnostic coincidence rate was 73.68%(14/19), and the tumor T-staging accuracy was 75%(12/16), respectively. Conclusions TRUS exhibits certain sonographic characteristics, with high preoperative diagnosis rate and tumor T-staging accuracy in anorectal malignant melanoma, which is of great guiding significance for clinical diagnosis and treatment.

Objective: To explore the sonographic features of primary testicular lymphoma(PLT). Methods: The sonographic features of 16 PLT patients confirmed by surgery and pathology were retrospectively analyzed. Results: Sixteen PLT patients were typed into 3 ultrasonic patterns: ①The diffuse homogeneous echo type: 2 cases, the ultrasonic features were homogeneous sieve-like hypoechoic echo, the blood flow signal was rich and radially distributed, with interstisial fibrosis inapparently under-microscope. ②The diffuse uneven homogeneous echo type: 9 cases, the ultrasonic features lobulated or map-like heterogeneous hypoechoic features, the blood flow signal was rich in linear distribution, and interstisial fibrosis proliferated to form fibrous septa under-microscope. ③The focal nodular pattern echo type: 5 cases, the ultrasonic features were homogeneous hypoechoic nodules, the blood flow signal was few, interstisial fibrosis hyperplasia surrounding the tumor under-microscope. Conclusions Ultrasonic appearances of primary testicular lymphoma are closely related to its pathologic characteristics, the recognization of their relations contributes to improve the diagnostic value of ultrasound.