Objective To analyze the influence factors of local efficacy by parametric contrast enhanced ultrasound (CEUS) of the hepatocellular carcinoma (HCC) patient treated with transcatheter arterial chemoembolization (TACE),and to investigate the application value of parametric CEUS in TACE.Methods From August 2011 to March 2014,a total of 61 HCC patients [60 men,1 women;age range:18-76 years,mean age:(53 ± 13)years old] who underwent one procedure of TACE were enrolled in this prospective study.All cases were scanned by CEUS 1-7 days before and after TACE (3 days,15 days and 30 days post-TACE).Analysis of tumor perfusion during the procedure of CEUS was performed with dedicated software (SonoLiver,TomTec,Germany and Bracco,Italy).Time-intensity curves were plotted and parameters were extracted.According to modified response evaluation criteria in solid tumors (mRECIST),we evaluated the response of TACE using contrast-enhanced computed tomography (CECT) and CEUS 30 days after TACE,which was as reference standard.Results There was a middle negative correlation between the reference standard and the PSV of the hepatic artery pre-TACE,and the correlation coefficient was 0.436 (P =0.011).There was a low negative correlation between the reference standard and the TTP of the reference region on 3 days post-TACE and the analysis region pre-TACE,and the correlation coefficient was -0.264 and-0.268 (P =0.047,P =0.037).Conclusions Our preliminary study suggests,some parameters of CEUS can predict the local response of TACE.

Objective: To compare the diagnostic performance of contrast-enhanced ultrasound (CEUS) with contrast-enhanced computed tomography (CECT) for the maximum diameter ≤2 cm metastatic liver cancer (MLC). Methods: Sixty-nine pathologically diagnosed MLC patients (maximum diameter ≤2 cm) were retrospectively recruited. The lesion detection rate, diagnostic confidence and enhancement pattern of CEUS and CECT for MLC were analyzed. Diagnostic value of CEUS and CECT for MLC were evaluated and compared by using diagnostic test. Results: The cases of 0, 1, 2, multiple lesions detected by CEUS and CECT in these 69 patients with ≤2 cm MLC were 0 case (0%), 41 cases(59.42%), 13 cases(18.84%), 15 cases(21.74%) and 9 cases(13.04%), 29 cases(42.03%), 13 cases(18.84%), 18 cases(26.09%), respectively. The positive cases detected by CEUS and CECT were 69 cases(100%) and 60 cases(86.96%) respectively, with a statistically significant difference between the two groups (P=0.006). However, for the detection rate of non-single-lesion cases, there was no statistical difference between CEUS and CECT (P=0.409). The cases showed typical manifestation in CEUS and CECT were 56 cases(81.16%)and 29 cases(42.03%)(P<0.001). The cases with diagnostic confidence level of 3, 4, 5 in CEUS were 3 cases(0.04%), 11 cases(15.94%), 55 cases(79.71%), and those of CECT were 19 cases(27.54%), 20 cases(28.99%), 20 cases(28.99%), respectively. The diagnostic sensitivity of CEUS and CECT for ≤2 cm MLC were 100% (69/69) and 85.51% (59/69), with statistically significant difference(P=0.001). Conclusions The lesion detection rate and diagnostic value of CEUS for the maximum diameter ≤2 cm MLC might be superior to that of CECT, but the detection rate shows no significant difference in the non-single-lesion cases. CEUS has important clinical value in the diagnosis of ≤2 cm MLC.

Objective To investigate the ultrasonography discrepancy of hepatic neuroendocrine neoplasm ( hNEN ) derived from different primary locations and pathological grades . Methods From August 2010 to April 2016 ,50 consecutive patients with 54 hNENs confirmed by pathology and imaging diagnosis underwent baseline ultrasound ( BUS ) and contrast-enhanced ultrasound ( CEUS ) in the First Affiliated Hospital of Sun Yat-sen University were enrolled in the retrospective study . On the basis of primary sites ,all hNENs were divided into three groups :pancreas ,gastrointestinal tract and other location groups . According to the pathological grading ,the hNENs were divided into hNET ( hepatic neuroendocrine tumor) group and hNEC ( hepatic neuroendocrine carcinoma) group . The imaging features of BUS and CEUS were retrospectively investigated and the ultrasonography discrepancy of hNEN derived from different primary focus and pathological grades were compared . Results ① Comparison of hNEN derived from different primary sites :hNEN derived from pancreas and gastrointestinal tract were smaller than hNEN derived from other sites[ ( 3 .8 ± 2 .6) cm vs ( 8 .7 ± 7 .0) cm , P = 0 .037 ;( 2 .9 ± 2 .1) cm vs ( 8 .7 ± 7 .0) cm , P = 0 .005] ,but the difference between the pancreas and gastrointestinal tract was not statistically significant ( P = 1 .0 ) . As for the pattern of CEUS enhancement ,hNEN derived from pancreas and gastrointestinal tract usually showed homogenous enhancement ( 13/19 ,15/23) while hNEN derived from other primary sites usually showed heterogeneous enhancement ( 10/13) ,and the difference was statistically significant ( P = 0 .025) . ② Comparison of hNET and hNEC :the distinction of enhancement level in the portal phase of contrast-enhanced ultrasound was statistically significant ( P = 0 .033) . All hNEC appeared hypo-enhancement ,while a small part of hNET ( 7/31 ) appeared iso-enhancement .More hNEC lesions showed heterogenous enhancemnt than hNET in the arterial phase ( 14/21 vs 9/31 , P = 0 .007) ,and there were less hNEC lesions presented tumor bleeding vessels than hNET ( 8/21 vs 22/31 , P = 0 .019 ) . Conclusions hNEN derived from pancreas and gastrointestinal tract are in a manner similar to hNEN derived from other primary sites on ultrasonography , so it' s difficult to identify in ultrasound . The ultrasonographic features of hNEC are more resemble to malignancy and it can be distinguished from hNET .

Objective To analyze the features of hepatic neuroendocrine neoplasm ( HNEN ) with conventional ultrasound and contrast-enhanced ultrasound sonography (CEUS) ,and to evaluate the value in the diagnosis and differential diagnosis of HNEN by ultrasound . Methods Fifty patients of HNEN confirmed pathologically or clinically were enrolled . All patients underwent conventional ultrasound and CEUS . Among the patients ,5 cases were primary hepatic neuroendocrine neoplasm ( PHNEN) ,and 45 cases were metastatic hepatic neuroendocrine neoplasm ( MHNEN) . Conventional ultrasound and CEUS features of HNEN were analyzed and the distinctions between PHNEN and MHNEN were compared . Results Baseline ultrasound showed that 37 (74％ ) HNEN were multiple lesions located in liver ,23 ( 46％ ) lesions with hyperechoic appearance ,35 ( 70％ ) lesions with homogeneous echoic ,28 ( 56％ ) lesions were clearly marginated ,8 (16％ ) lesions were surrounded by acoustic halo ,and 12 ( 24％ ) lesions with posterior echo attenuation . CEUS showed that the majority of HNEN exhibited the enhanced pattern of rapid wash-in and wash-out" . Forty-six ( 92％ ) lesions showed hyper-enhancement in the arterial phase ,44 ( 88％ ) lesions showed iso-enhancement in the portal phase ,and 47 ( 94％ ) lesions showed hypo-enhancement in the late phase .Feeding vessels were observed in 31 ( 62％ ) lesions ,intralesional non-enhancement zone was observed in 17(34％ ) lesions ,and capsule enhancement in the delay phase was found in 10( 20％ ) lesions . MHNEN had smaller diameter [ ( 3 .92 ± 2 .77) cm vs (12 .82 ± 8 .85) cm , P = 0 .004] and less likely to present cystic structure intralesional than PHNEN ( 1/45 vs 2/5 , P < 0 .001 ) . The differences of other baseline ultrasonographic characteristics ,enhanced characteristics and enhanced time on CEUS between PHNEN and MHNEN were not statistically significant ( all P > 0 .05) . Conclusions HNEN has a certain characteristic that can be identified on ultrasonography . Ultrasound can provide some valuable information to diagnose HNEN . While it′s difficult to differentiate PHNEN and MHNEN owing to their similar ultrasonographic characteristics .

Objective To evaluate the effect of artificial ascites under ultrasonic guidance in the thermal ablation of liver or kidney tumors ,so as to provide basis for successfully creating artificial ascites , increasing the complete ablation rate of the tumors and reducing the damage of important organs . Methods Seven hundred and thirty-six patients with artificial ascites were performed under ultrasonic guidance during the thermal ablation of liver or kidney tumors and six hundred and seventy-nine patients were successfully performed . The success rate of creating artificial ascites at different sites ,time requirement ,the effect of ascites , puncture times were analyzed , while curative effect and complications were evaluated and summarized . Results The success rate of creating artificial ascites was 92 .3％ ;the average time of creating artificial ascites was( 9 .1 ± 1 .3) minutes ;the average puncture times was( 1 .1 ± 0 .2) times ;complete ablation was 98 .7％ ;the complication of ascites creation was 0 .44％ ,minor complications after ablation was 6 .20％ , severe complications was 0 .59％ . The required fluid volume and success rates for the creation of artificial ascites in different sites were different . The volume of fluid needed was relatively high in the liver-gastric space ,and the success rate was relatively low ;the success rate of liver septum and liver -kidney crypts was the highest . Heat injury complications of the important organs such as gastrointestinal tract ,esophagus , diaphragm near the liver or kidney tumors were 0 . Conclusions The establishment of artificial ascites improves the local curative effect and reduces the complication of tumors ablation in difficult locations . The methods and effect of artificial ascites in different parts of liver or kidney are different .

Objective To prepare ultrasound(US)responsive nanodroplets(NDs)simultaneously loaded with anticancer drug Sorafenib(SF)and Doxorubicin(DOX),and to characterize its ultrasound responsibility in vitro and in vivo.Methods The SF/DOX NDs were prepared using the thin-film hydration method.The particle diameter,Zeta potential and drug-encapsulation efficiency were characterized.The acoustic droplets vaporization activity was monitored by in vitro ultrasound imaging and light microscope. The cavitation effect was monitored by in vitro ultrasound imaging and transmission electron microscopy. Results SF/DOX NDs were round in shape,the mean diameter and Zeta potential of SF/DOX NDs was (498 ± 67.34)nm,-(38.87 ± 3.78)mV,respectively.The entrapment efficiency of SF and DOX was (58.14±2.93)%,(51.23±4.11)%,respectively.SF/DOX NDs underwent a phase transition into bubbles and could be continuously imaged for more than 25 min in vitro,and afterward therapeutic ultrasound pulse induced inertial cavitation and substantially enhanced treatment.Conclusions US-responsible SF/DOX NDs are prepared using thin-film hydration mehtod,it can enhance ultrasonic echo in vitro and release anticancer drug by the aid of US exposure,which possesses greater researching and applicating value.

Objective To evaluate the safety and effective of ultrasound-guide percutaneous radio frequency ablation (RFA).Methods Retrospectively analyze the incident,management and influence factors of complication of ultrasound-guide percutaneous RFA.Results From 2001 to 2011,536 patients with 762 lesions underwent RFA were enrolled in this study.Incident of RFA complication was 2.03％ (11/536),including 5 (0.92％) major complication.The complication covered fever (1 case),massive hydrothorax (2 cases),hydrothorax accompany with ascites (1 case),massive ascites (1 case),liver abscess (1 case),liver capsule hemorrhage (1 case) and hemothrorax (1 case).No RFA relate mortality was observed.According to logistics regression analysis,the liver function Child-Pugh grading was associated with the RFA complication (P =0.005).Conclusions Ultrasound-guide percutaneous RFA is a safe and effective local treatment approach for hepatocellular carcinoma.It's necessary to comprehensively think over the basic condition of patients and the characters of tumor such as tumor location,size and abutting organs.Nevertheless,an appropriate treatment plan and closely monitor during and after RFA are crucial.

Objective To comparatively analyze CEUS features of hepatitis B virus (HBV)-related combined hepatocellular-cholangiocarcinoma (CHC) and hepatocellular carcinoma (HCC).Methods Thirty-one patients with HBV-related CHC and 31 patients with HBV-related HCC confirmed by pathology were enrolled and CEUS features were compared.Results On CEUS,HBV-related CHC and HBV-related HCC mainly manifested as hyper-enhanced in arterial phase and hypo-enhanced in portal phase and delayed phase.No significant differences of enhancement level on CEUS were found between HBV-related CHC and HBV-related HCC.When the maximum diameter of tumor ≤3.0 cm,both HBV-related CHC and HBV-related HCC were mainly homogeneous enhancement (P=1.000).When the maximum diameter of tumor more than 3.0 cm,diffuse heterogeneous enhancement and peripheral irregular rim-like enhancement were more commonly observed in HBV-related CHC,while diffuse heterogeneous enhancement was more commonly noted in HBV-related HCC (P=0.001).Conclusion The enhancement pattern of HBV-related CHC ＞3.0 cm has relative specific performance.

Objective To evaluate the correlation between the imaging features on contrast-enhanced ultrasound (CEUS) and pathological characteristics of combined hepatocellular-cholangiocarcinoma (CHC).Methods Forty patients with pathologically proven hepatic CHC were evaluated,the CEUS imaging findings and pathological characteristics of CHC were retrospectively analyzed.Results On CEUS,peripheral irregular rim-like enhancement,diffuse heterogeneous enhancement and diffuse homogeneous enhancement were illustrated in 13(32.5 ％),21 (52.5 ％) and 6(15.0％) lesions,respectively.Pathological findings showed that HCC-predominance,CC-predominant,and similar proportions of the two components were illustrated in 16 (40.0 ％),19 (47.5 ％) and 5 (12.5 ％) cases,respectively.The presence of necrosis were illustrated in 28 (70.0％) cases.On CEUS,when the enhancement pattern was peripheral irregular rim-like enhancement,CC-predominance and necrosis were presented in 11(84.6％) and 10(76.9％) cases,respectively.When the enhancement pattern was diffuse heterogeneous enhancement,CC-predominance and necrosis were presented in 11(52.4％) and 18(85.7％) cases,respectively.When the enhancement pattern was diffuse homogeneous enhancement,HCC-predominance and necrosis were presented in 4(66.6％) and 0 (0％) cases,respectively.There were significant differences in relative proportion of HCC,CC components and tumor necrosis among the three types of enhancement pattern on CEUS (P =0.009 and P ＜ 0.001).When CHCs were ≤ 5 cm,peripheral irregular rim-like enhancement,diffuse heterogeneous enhancement and diffuse homogeneous enhancement were illustrated in 5,3 and 5 cases,respectively.When CHCs were ＞5 cm,peripheral irregular rim-like enhancement,diffuse heterogeneous enhancement and diffuse homogeneous enhancement were illustrated in 8,18 and 1 cases,respectively.There were significant differences in the three types of enhancement pattern between lesion size of ≤5 cm and ＞5 cm on CEUS (P =0.006).Conclusions The imaging findings of CHC on CEUS depends on the relative proportions of HCC and CC component and on size-dependent patterns.

Objective To investigate the utility of virtual endoscopy ultrasound Fly-Thru in the diagnosis of obstructive bile duct diseases.Methods One-hundred patients with obstructed bile duct diseases underwent Fly-Thru examination.All Fly-Thru images were reviewed by two radiologists with different experience.The capabilities of Fly-Thru for bile duct obstructive degree evaluation and distinguishing malignant lesion from benign one were assessed respectively.Results The accuracy and sensitivity of Fly-Thru image in obstruction degree evaluation were 70.59％ and 89.2％ (95％CI 74.6％-96.9％).The diagnosis accuracy of 2DUS for lesion characteristics increased from 80％ to 84％,accompany with Fly-Thru images,especially for lesions in common bile duct from 77.2％ to 86.0％ (x2 =14.399,P =0.001).Conclusions The virtual endoscopy ultrasound Fly-Thru is only partly capable to display the obstructed degree of some bile ducts,but it can improve the diagnostic accuracy of common bile duct diseases.