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 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 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 investigate the value of high frequency ultrasound combined with color Doppler flow imaging in diagnosis and classification of trauma of penis on the clinical treatment . Methods T he sonographic features of 48 cases with penile trauma were analyzed and compared with treatment outcomes . Results T he ultrasonic findings of penile trauma ranged from penis contusion to penis fracture . According to the sonographic features ,the trauma of penis was grouped as follow s :Type 1 ,penis bruise ( 7 cases) presented with images of continuous penis skin and tunica albuginea ,inhomogeneous echoes of subcutaneous tissue . Type 2 ,corpora cavernosa bruise ( 4 cases ) showed images of continuous tunica albuginea ,inhomogeneous internal echoes of corpora cavernosa without abnormal flow signal . T he corpora cavernosa swelling into honeycomb‐like ,anechoic area of cavernosa with high‐speed artery Doppler signals w hen accompanied by cavernous artery injury . Four cases were treated conservatively . Type 3 ,the skin and subcutaneous tissue contusion ( 6 cases) manifested images of incontinuous and inhomogeneous echoes of skin and subcutaneous tissue but homogeneous echoes of corpora cavernosa and tunica albuginea . Six cases of patients underwent debridement and sutured by local anesthesia . Type 4 ,rupture of tunica albuginea( 26 cases) revealed images of incontinuous and irregular local tunica albuginea ,a hematoma seen between the tunica albuginea and subcutaneous tissue . Type 5 , penile fracture ( 5 cases ) revealed mostly or fully disconnected skin and corpora cavernosa ,tearing of blood vessels . T he patients of type 4 and 5 were all treated surgically . Conclusions Color Doppler ultrasonography could provide accurate assessment and classification for trauma of penis ,w hich is helpful to offer a reliable basis for clinical treatment scheme .

To discuss the value of color Doppler ultrasonography in the diagnosis and differential diagnosis of ureteral polyps ( U P) . Methods Ninety‐five cases with pathologically proven U P and 104 cases with pathological confirmed urinary tract urothelial carcinoma ( U T UC) were enrolled in the study . T heir positive rate of color Doppler ultrasonography exam preoperatively were retrospectively analyzed and compared with pathological findings . Results Compared with pathological diagnosis , the accordance rate of color Doppler ultrasonography localization were 82 .1% ( 78/95) and 80 .8% ( 84/104) for U P and U T UC respectively ,the accordance rate of qualitative diagnosis were 69 .2% ( 54/78 ) and 90 .5%( 76/84) . Color Doppler ultrasonographic features of U P displayed a clear demarcation between the pipe wall of ureter and surrounding tissue .However ,such clear demarcation could not be found in U T UC . T he accordance rate between two groups has statistically significant difference ( P ＝0 .000 6 ) . Color Doppler ultrasonographic image showed no blood flow in the ureteral polyps ,while mainly minor or medium amount of blood stream signals were found in most tumors of U T UC . According to Adler blood flow grading and the blood flow detective rate ,the two groups demonstrated statistically significant difference ( P ＜0 .05 ) . Conclusions With high resolution color Doppler ultrasonography and flexible operation technique ,it can clearly observe the internal structure of ureter at obstruction end as well as boundary conditions of peripheral tissue ,w hich will play a profound role in preoperative diagnosis and differential diagnosis of U P .

Objective To analyze the ultrasonic features of papillary thyroid microcarcinoma (PTMC) with different size and location,and to investigate the relationship of aspect transverse ratio (A/T) and capsule invasion in PTMC.Methods Totally 407 patients of PTMC with 495 nodules confirmed by pathology were enrolled.The nodules were divided into largest diameter≤0.5 cm group and largest diameter＞0.5 cm group.The ultrasonic signs of nodules were observed,and the relationship between A/T and thyroid capsule invasion was analyzed.Results The differences of blood type,relationship with capsule,calcification,morphology and A/T were statistically significant between the two groups (all P＜0.05).In nodules closed to capsule and A/T≥1,the rate of capsule invasion in diameter＞0.5 cm group (117/185,63.24％) was higher than that in diameter≤0.5 cm group (25/61,40.98％,P＜0.01).Taking A/T≥1 as the standard,the sensitivity of A/T in estimating capsule invasion of nodules closed to capsule in diameter≤0.5 cm group and diameter＞ 0.5 cm group was 89.29％ and 73.58％,the specificity was 29.41％ and 37.61％,respectively.In nodules adjacent to capsule and broken through capsule,the difference of capsule invasion rate was not significant between nodules with A/T≥1 and A/T＜1 (both P＞0.05).In nodules that contact capsule,the capsule invasion rate of A/T≥1 nodules (46/67,68.66％) was higher than that of A/T＜1 (10/27,37.04％).Taking A/T≥1 as the standard,the sensitivity of A/T in estimating capsule invasion of nodules touched capsule was 82.14％,and the specificity was 44.74％.Conclusion Ultrasonography can show the size,A/T and relationship with capsule in PTMC,which can provide diagnostic evidences in judging capsule invasion of PTMC.

Objective To discuss the value of color Doppler ultrasound in the diagnosis and differential diagnosis of ovarian granulosa cell tumor (OGCT) . Methods Fourteen cases were diagnosed as OGCT by pathology postoperatively had been examined by color Doppler ultrasound check-up before the surgery . In image appearance ,the tumors were divided into cystic mass ,solid mass or mixed cystic-solid mass respectively according to their own pathological features . Additionally ,the blood flowing signal of OGCT was labeled from 0 to 3 grade with Adler standard based on the blood flowing imaging observed by color Doppler flow imaging ( CDFI) . The CDFI results were compared with the pathological diagnosis . Results Ultrasound image appearance of OGCT varied in the 14 cases .Two of them could be characterized as cystic mass ,5 solid mass and 7 mixed cystic-solid mass . The mixed cystic-solid OGCT contained solid mass in multiple cystic degeneration area . There was a significant difference in the diameter among three kinds of OGCT ( P = 0 .0006) . The more visible cystic lesion indicated the longer diameter of OGCT . According to the CDFI ,4 ,5 ,3 and 2 cases were 0 ,1 ,2 ,3 grade respectively in Adler standard . No significant difference was found among the four standards groups ( P =0 .056) . The localization diagnosis accordance rate of the Doppler imaging in OGCT was 71 .4％ (10/14) and the qualitative diagnosis accordance rate was 35 .7％ (5/14) . Conclusions The color Doppler ultrasonography can be the first-line preoperative imaging investigation in the diagnosis and differential diagnosis of OGCT ,as well as in the long-term following after surgery . It can provide more details and evidences for the treatment and prognosis assessment of OGCT .

Objective To discuss the value of color Doppler ultrasonography in the diagnosis and differential diagnosis of urinary tract urothelial carcinoma (UTUC).Methods Color Doppler ultrasonography exam was practiced in 84 UTUC patients preoperatively.According to ultrasound characteristics,lesions was classified into nodular type,wall thickening type and solid mass type,which were confirmed by pathology in all cases postoperatively.Results In the total of 84 cases (76 transitional-cell carcinoma,5 adenocarcinoma and 3 epidermoid carcinoma),lesions infiltrated laminae propria and surrounding tissue in 65 cases.In the nodular type of UTUC,there were nodules raising into lumen.Wall thickening type of UTUC was characterized by irregularly wall thickening,lumen narrowing,truncating and breaking.Similarly,obstruction broke off the ureteral lumen suddenly in solid mass type of UTUC.A clear demarcation could be found between the pipe wall and surrounding tissue in nodular type.However,such clear demarcation could not be found in wall thickening type and solid mass type.The accordance rate of ultrasonographic located diagnosis were 92.9 ％ (78/84),with 6 missed diagnosis cases.The accordance rate of qualitative diagnosis were 89.7％ (70/78).Conclusions As result of color Doppler ultrasonography,there were different relationship between lesion and the peripheral tissue in different types of UTUC.In types of wall thickening and solid mass,the demarcation was unclear and it is easier to violate the surrounding tissue.Color Doppler ultrasonography can provide more effective information for diagnosis and therapy UTUC.

Objective To explore the sonographic features of intrascrotal adenomatoid tumor.Methods The sonographic features of 21 cases with intrascrotal adenomatoid tumor confirmed by surgery and pathology were retrospectively analyzed.Results Twenty-one cases with intrascrotal adenomatoid tumor could be typed into 3 ultrasonic patterns:(1) The homogeneous echo type:15 cases,their ultrasonic features were homogeneous echo,including 5 cases with low echo,8 case with equal echo,and 2 case with high echo;5 cases with testicular albuginea adenomatous tumors were also homogeneous echo,2 cases of equal echo,2 cases of low echo and 1 case of high echo that was posterior echo attenuation slightly.(2) The edge halo type:4 cases,they showed the epididymis or testis sheath round or oval nodules,of which the middle was low echo and the edge is high echo halo ring.(3) The mixed echo type:2 cases,they showed cystic mixed echo of epididymis nodules,1 case with irregular cystic areas and poor sound transmission,while the other one with good sound transmission cystic areas and a small papillae on the wall.Conclusions Sonography is a valuable method for diagnosis of intrascrotal adenomatoid tumor.The edge halo type has sonographic features.