Objective:To investigate the effectiveness and safety of the coaxial needle technique in percutaneous liver biopsy for patients with coagulation function abnormalities.Methods:Clinical data of 210 patients who underwent percutaneous liver biopsy using the coaxial needle technique under ultrasound guidance from December 2018 to May 2021 in 3 centers were collected. A retrospective analysis was conducted to compare the puncture success rate, number of samples obtained, pathology qualification rate, intraoperative and postoperative bleeding rates between the group with coagulation function abnormalities and the group with normal coagulation function.Results:After propensity score matching, there were 105 patients in each group, with a puncture success rate of 100% in both groups. The pathology qualification rate was 100% for all samples.Intraoperative bleeding occurred in 78 cases (74.3%, 78/105) in the coagulation function abnormalities group and in 64 cases (61.0%, 64/105) in the normal coagulation function group, with a statistically significant difference between the two groups ( P=0.006). Postoperative bleeding occurred in 3 cases (2.9%, 3/105) in the coagulation function abnormalities group and in 0 case in the normal coagulation function group, with no statistically significant difference between the two groups ( P=0.081). Conclusions:The use of the coaxial needle technique for percutaneous liver biopsy in patients with coagulation function abnormalities not only allows for obtaining an adequate tissue sample but also demonstrates good safety.

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 feasibility and accuracy of three-dimensional ultrasound-ultrasound (3DUS-US)automatic image fusion technology based on electromagnetic positioning.Methods The experimental phantom was constructed to acquire ultrasonic images by agarose gel and additives,which was used as the experimental object.3DUS imaging with free-hand and real-time ultrasound imaging automatic registrations were performed based on electromagnetic positioning.To investigate the effect of 3DUS-US image fusion under different scanning speed by free-hand,the fast and slow groups were designed. In addition,a junior operator and a senior operator performed 3DUS-US automatic registrations,and recorded the operating time and registration error,respectively.The repeatability between two operators was analyzed.Results The macroscopic appearance,stability and ultrasonic image of the phantom met the demand of this research.The success rate of 3DUS-US automatic image fusion technology was 100%(40/40).The slow group's registration error distance was (1 .44 ± 0.64)mm,which was obviously lower than the fast group's (2.56±0.53)mm,the difference was statistically significant (P <0.001).There were no statistically differences of the registration error and operating time between the two operators (P =0.508,P = 0.5 1 7 ).Conclusions The technology of 3DUS-US automatic registration based on electromagnetic positioning was feasible and accurate,which is worth applying into the clinical treatment.

Objective To compare the accuracy,convenience and repeatability of 3DUS-US and CT-US image fusion technology based on electromagnetic positioning.Methods A tissue-mimicking phantom was established and used to obtain ultrasound or CT volume images.Two different operators performed 3DUS-US and CT-US image fusion and repeated 10 times,respectively.The success rate,the registration error distance and fusion time of two techniques were recorded and compared between the different operators.Results The ultrasound and CT images of the phantom and its stability could meet the demands of this experiment.3DUS-US and CT-US image fusions were successful.The registration error distance of 3DUS-US image fusion was (1 .70 ± 0.42)mm and fusion time was (76.00 ± 9.99)s,they were obviously superior to CT-US (P = 0.014,P < 0.001 ).There were no significant differences between the two operators in the registration error distance and fusion time of 3DUS-US (P =0.508,P =0.5 1 7).But the registration error distance of CT-US image fusion in experienced operator was lower than the junior (P =0.009),and fusion time had not statistical difference between the two operators (P =0.234).Conclusions The technique of 3DUS-US automatic image fusion based on electromagnetic positioning has advantages of convenience and no experiential dependence comparing with CT-US in the phantom experiments,so it is worthy of being widely popularized in clinical application.

Objective To explore the value of contrast-enhanced ultrasound (CEUS) in the differential diagnosis of subserous myoma (SM) and ovarian fibroma.Methods CEUS was performed on 58 patients with SM and 26 patients with ovarian fibroma.The enhancement pattern was observed.The diagnostic performance was evaluated by using diagnostic test.Results SM exhibited homogeneous isoenhancement synchronously with the myometrium in early phase.In the late phase,the pseudocapsule remained hyper-enhancement with obvious membraniform sign.Some myomas showed the feeding artery from uterus.Ovarian fibroma demonstrated hyper-enhancement at the periphery portion and hypoenhancement inside.Conclusions The SM and ovarian myomas showed different enhancement patterns,which may provide us some exact information in the differential diagnosis between the two diseases.

Objective To demonstrate the feasibility and accuracy of the intellectual position(IP)technique used in ultrasound-guided biopsy.Methods Several red spheres,which were 10 mm in diameter and visible in ultrasound,randomly placed in the tissue mimicking gel phantom.The biopsy was performed by two operators respectively.Each operator chose 25 spheres,each of which were performed biopsy guided by IP technique,free-hand ultrasound and ultrasound with guide bracket.The red dye in the biopsied sample meant successful performance.The time spend in per biopsy target,the success rate of biopsy and the length of the red dyed sample of the three methods were recorded,and comparison was made among them.Results The median time took in biopsy guided by IP technique was 95(rang,80-110)s,which was longer than that of free-hand ultrasound-guide[30 (rang,22-42) s,P ＜0.001] and ultrasound-guide with bracket [20(rang,15-28)s,P ＜0.001].The success rate of biopsy guided by IP technique was 98.0％ (49/50)which was as well as that guided by ultrasound-guide with bracket(96.0％,48/50,P =0.558),better than free-hand ultrasound-guide(78.0％,39/50,P =0.002).The median length of red dyed sample biopsied guided by IP technique was 8.0 (rang,7.0-8.5)mm,which was longer than that of free-hand ultrasoundguide[6.0(rang,4.0-8.0)mm,P =0.003] and ultrasound-guide with bracket[7.0(rang,6.0-8.0)mm,P =0.003].There was no statistically difference between the two operators in length of red dyed sample and success rate of biopsy guided by IP technique(P ＞0.05).Conclusions Biopsy guided by IP technique is a feasible and accuracy method,which will become an effectively supplement of the ultrasound-guide with bracket.

Objective To design and construct a hepatocellular carcinoma(HCC) phantom,and assess the accuracy of three dimensional ultrasound (3DUS)-CT image fusion in evaluating ablative margin (AM).Methods The phantom was constructed by carrageenan gel and additives.A sphere-shaped HCC model surrounded by a 5 mm layer of AM model was embedded into a cylindrical-shaped ground substance model to form the phantom.After radiofrequency ablation (RFA),HCC model in the phantom was ablated into ablative lesion model.The ultrasound and CT image,macroscopic appearance and stability of the phantom were observed.Twenty-four phantoms were made and ablated into different ablative lesion models in which AM was achieved or not achieved.Outline the HCC and 5mm AM in the 3DCT image and fuse 3DCT image with the 3DUS image of the ablative lesion model to see whether the ablative area could cover the AM,as well as in which quadrant complete ablation of the AM had not been achieved and the maximal thickness of the unachieved AM.The result of the 3DUS-CT image fusion was compared with gross specimen.Results The ultrasound and CT image,macroscopic appearance and stability of the phantom met the demand of this study.The sensitivity,specificity and accuracy of 3DUS-CT image fusion were 93.8％,85.7％ and 91.3％respectively.The quadrant in which complete ablation of AM was not achieved matched with gross specimen.The maximal thickness of the unachieved AM measured by 3DUS-CT image fusion and gross specimen were (3.5 ± 2.0) mm and (3.2 ± 2.0) mm respectively,and no statistic difference was found between the two results.Conclusions The phantom made of carrageenan gel and additives was suitable for the evaluation of AM.3DUS-CT image fusion evaluation of AM was accurate.

Objective To evaluate virtual navigation assisted contrast-enhanced ultrasound(VN-CEUS) by comparing VN-CEUS with routine CEUS in detecting focal liver lesion(FLL) invisible in B-mode ultrasound(BUS).Methods Forty-seven FLLs invisible in BUS were identified by CT/MR,and received VN-CEUS and routine CEUS respectively.Results The detection rate of VN-CEUS and routine CEUS were 78.7%(37/47) and 36.2%(17/47),the former was much higher than the later (P<0.01).In all the cases,fusion of CT/MR with ultrasound was achieved successfully and average time for image fusion was 5 min.compared with routine CEUS,VN-CEUS could more easily find FLLs shadowed by lung or ribs,FLLs in inhomogeneous liver background,and FLLs with brief or inapparent abnormal enhancement.ConclusionsVN-CEUS can greatly improve the detection rate of FLL that was invisible in BUS.

Objective To assess the feasibility and accuracy of the transvaginal three-dimensional hysterosalpingo-contrast sonography(3D HyCoSy) on the fallopian tube patency. Methods 3D HyCoSy was performed in twenty-two cases with infertility. Image quality of 3D HyCoSy was evaluated. The estimate of the fallopian tube patency in 3D HyCoSy were compared with those of hysterosalpinography(HSG) in one week. Results The mean score of image quality of 3D HyCoSy in twenty-two cases was 2. 8 + 0. 5. The accuracy of the unobstructed and obstructed fallopian tube were 88.9% (24/27) and 94.1% (16/17) respectively, and the total accuracy was 90. 9% (40/44) , which was equal to the results of HSG (P = 0. 000,k = 0. 812). No adverse reactions of SonoVue occurred in the cases. Conclusions Transvaginal 3D HyCoSy which is a new imaging technique can safely and effectively display the morphological character of fallopian tube and assess the patency.

Objective To evaluate the value of virtual navigation assisted 3-D contrast-enhanced ultrasound (VNA-3D-CEUS) in depicting ablative area and ablative margin after hepatocellular carcinoma radiofrequency ablation. Methods Sixty-one lesions in 51 patients were evaluated ablative area and ablative margin using VNA-3D-CEUS. The results were divided into three groups: (A) tumor was completely ablated and 5 mm ablative margin was achieved; (B) tumor was completely ablated but 5 mm ablative margin was not achieved; (C) tumor was not completely ablated. The technical successful rate of VNA-3D-CEUS,as well as the coincidence rate of complete ablation with contrast-enhanced MRI,was evaluated. The relation between local tumor progression and ablative margin was observed through follow-up. Results The technical successful rate of VNA-3D-CEUS was 78.7％ (48/61). Coincidence rate of complete ablation with contrast-enhanced MRI was 100％ (40/40). The local tumor progressions of group A and group B were 0/26 and 2/13. There was significant difference between A and B group( P =0.032). Significant correlation between local tumor progression and ablative margin was found ( r =- 1. 000, P ＜0. 001 ). Conclusions VNA-3D-CEUS could be a new method in accurately evaluating the ablative area and ablative margin after hepatocellular carcinoma ablation.