Objective Evaluation of left ventricular ( LV) function has great clinical significance in patients with early chro-nic kidney disease (CKD).The study was to evaluate whether two-dimensional speckle tracking imaging (2D-STI) technique can offer additional information of cardiac dysfunction in early CKD patients . Methods Conventional echocardiography and 2D-STI echocar-diography were performed in CKD group of 20 patients at stage Ⅱ-Ⅲ and control group of 20 healthy volunteers .LV structure and function were evaluated by conventional echocardiography .Multidirectional strain , strain rate and LV twist parameters were analyzed by 2D-STI technique. Results There was no statistical difference in conventional echocardiographic parameters such as left atrial diam -eter, end-diastolic LV diameter and ejection fraction between CKD group and control group .By applying 2D-STI technique, CKD group had significantly decreased value of global longitudinal strain (-19.8 ±2.4)%and strain rate(-1.1 ±0.3)S-1 in comparison to control group(-22.6 ±2.1)%、( -1.8 ±0.2)S-1, along with significant increase in the values of maximum LV rotation (11.6 ± 4.4)°and LV twist(19.6 ±3.8)°in comparison to control group(8.2 ±3.7)°、(13.5 ±3.6)°(P<0.05).There was no differences in both global circumferential and radial deformation parameters as well as maximum rotation value of LV assist device between two groups(P>0.05). Conclusion 2D-STI can detect subclinical LV dysfunction sensitively in early CKD patients .

Objective This study was to analyze the causes of the complications of ultrasound -guided percutaneous renal bi-opsy in children . Methods We retrospectively analyzed the complications of ultrasound-guided percutaneous renal biopsy in 236 children along with the age, sex, sample length, times of puncture, and types of disease of the patients .We used the binary Logistic regression model to analyze the influences of various factors on the post -biopsy complications . Results After renal biopsy , 22 (9.3%) of the patients experienced various degrees of but no severe complications .The incidence of complications was significantly correlated with the sample length (P<0.05), but not with the age, sex, sample length, times of puncture, and types of disease of the patients. Conclusion Ultrasound-guided percutaneous renal biopsy is an effective diagnostic method for children , with a high suc-cess rate and a low incidence of complications .And the incidence of complications can be reduced by improving the skills of puncturing and accuracy of ultrasound positioning .

Objective To investigate the correlation between elasticity obtained with acoustic radiation force impulse(ARFI) and blood perfusion obtained with contrast enhanced ultrasound(CEUS) in renal carcinoma.Methods Tweenty-four patients with renal carcinoma confirmed by operation and pathology underwent ARFI and CEUS sequentially,got preliminary information of elasticity,size and border with virtual touch tissue imaging (VTI),shear wave velocity (SWV) of tumor and renal cortex at least 2centimeters from the tumor margin were measured with virtual touch tissue quantification (VTQ),and then the imaging characteristics were analyzed with time intensity curve (TIC).The elasticity obtained with ARFI were compared with the blood perfusion obtained with CEUS.ResultsTotally 24 cases included 18 renal cell carcinomas,3 papillary renal cell carcinomas,2 chromophobe cell renal carcinomas and 1 rena1collecting duct carcinoma.In VTI,18 appeared darker,4 appeared brighter,and 2 had the same brightness as renal cortex.The SWV of tumor and renal cortex were (2.47±0.61)m/s,(2.10±0.94) m/s,respectively,19 were stiffer than renal cortex (79.2％),among which 18 appeared hyper-enhancement and 1 appeared hypo-enhancement;5 were softer than renal cortex (20.8％),among which 2 appeared hyper-enhancement and 3 appeared hypo-enhancement in CEUS.Tumors with different elasticity had different enhancement,stiff cases appeared hyper-enhancement,soft cases appeared hypo-enhancement (P ＜ 0.05).Conclusions There is correlation between elasticity obtained with ARFI and blood perfusion obtained with CEUS in renal carcinoma

Objective To evaluate whether global 2-dimensional strain imaging can offer additional benefit over conventional echocardiography to detect subclinical myocardial damage in patients with chronic kidney disease(CKD). Methods Conventional echocardiography and global 2-dimension strain imaging were performed in 39 patients with CKD [23 men and 16 women,mean age (45.6± 14.6) years] and 29 control subjects. Twenty patients had CKD stage 2 or 3(group 1 ) and nineteen patients had CKD stage 4 or 5(group 2). Left ventricular structure and function were evaluated by conventional echocardiography. Global longitudinal and circumferential strain and strain rate were analyzed. Results There were no differences in ejection fraction and fraction shortening between CKD patients and controls. Compared with controls, CKD groups had significantly decreased value of global longitudinal strain and strain rate. Global longitudinal strain decreased from - (23.8 ± 3.1 ) % in controls to - ( 18. 5 ± 2.4) % in group 1 and to - (15.2 ± 3.2) % in group 2 ( P ＜0. 001 ). Compared with controls, there was no difference in global circumferential strain and strain rate between group 1 and controls, but global circumferential strain and strain rate of group 2 was reduced [ - (17.1± 3. 0) % vs -(21.2±2.8)%, P＜0.05;-(1.0±0.2)% vs -(1.3±0.3)%, P＜0.05]. In correlation analyses, global longitudinal strain was positively related to eGFR( r =0. 376, P ＜0. 001 ) and inversely related to left ventricular mass index( r = - 0. 473, P ＜0.01). Conclusions Global 2-dimensional strain imaging may represent a useful tool for the assessment of subclinical myocardial dysfunction in patients with CKD.

Objective To investigate the value of contrast enhanced ultrasound(CEUS) with microbubbles targeted to vascular endothelial growth factor receptor type 2 (VEGFR2) for imaging tumor angiogenesis in murine tumor models.Methods Established human renal cell carcinomas(RCC) subcutaneous xenograft tumor model in nude mice,microbubbles targeted to VEGFR2(MBV) was prepared,control microbubbles(MBC) and MBV were injected respectively in each mouse,the intensity of each microbubble was compared,the expressions of VEGFR2 in tumors were tested by immunohistochemistry.Results CEUS imaging showed the intensity of MBV and MBC was (6.50±1.43)dB,(2.59±0.99)dB,respectively.There was significantly higher intensity when using MBV compared with MBC (P<0.01).The time to wash out was longer in MBV contrast group compared with MBC group.Immunohistochemistry showed VEGFR2 was highly expressed in novel vessel walls.Conclusions Contrast microbubbles targeted to VEGFR2 can specially enhance the images of RCC and has tremendous significance in the assessment of angiogenesis.

Objective To discuss the imaging characteristics of chromophobic cell renal carcinoma (CCRC) and study the features on the contrast-enhanced ultrasound (CEUS). Methods The CEUS features of CCRC in 28 cases identified by pathology were reviewed. The blood supply and enhancement characteristic were observed and analyzed on time intensity curve parameters. Results The 28 cases of CCRC showed poor blood supply in contrast with the renal cortex. The CCRC presented with heterogeneity enhancement, part of the tumor took on a high wash-in and wash-out, and enhanced less intense than the surrounding renal cortex. The actinomorphous strong echo of the tumors might be revealed with CEUS in 15 cases (54%). The time intensity curve analysis demonstrated that the CCRCs' difference of peak intensity and area under the curve were lower than the renal cortex (P＜0.05), but arrival time, time-to-peak and slope of ascending curve were higher than the renal medulla (P＜0.05). Conclusion The actinomorphous enhancement and poor blood supply in the tumor of CEUS could provide diagnostic evidence for CRCC.

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 analyze the misdiagnosis reasons in renal tumors with contrast-enhanced ultrasound (CEUS) and to improve cognition on CEUS. Methods Two-hundred and eighty-five cases were compared with pathology, the images in 22 cases misdiagnosed on CEUS were reviewed retrospectively and the reasons were analyzed. Results The diagnosis accuracy and misdiagnosis rate of CEUS were 92. 28 % (263/285) and 7. 72%(22/285), respectively. In these 22 cases, 9 cases misdiagnosed as renal cell carcinoma (RCC) were conformed by pathology as renal angiomyolipoma(RAMD), showed 5 cases "fast wash-in and fast wash-out", 4 cases "fast wash-in and slowly wash-out". Seven cases were conformed as RCC, in which 5 were misdiagnosed as RAML, showed 4 cases "fast wash-in and slowly wash-out", 1 cases "simultaneously wash-in and simultaneously wash-out", and 2 were misdiagnosed as renal cyst with no enhancement founded. Four cases misdiagnosed as hematoma were conformed as pyelo-carcinoma, with no enhancement founded in renal pelvis. The remaining 2 cases misdiagnosed as inflammatory pseudotumor were conformed as RCC, showed "fast wash-in and slowly wash-out". Conclusions With the high diagnosis accuracy,CEUS is an important method in diagnosis of renal tumors. Analyzing the misdiagnosed reasons may improve the cognition on CEUS and decrease the misdiagnosis.

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.