OBJECTIVE: To conduct signature analysis for splenic trauma in canines during hemorrhagic shock and resuscitation by contrast enhanced ultrasonography (CEUS). METHODS: Forty grade III-IV traumatic splenic lesions were established in 15 mongrel dogs. Hemorrhagic shock was induced in these animals by using the modified Wiggers's method. Animals in shock were then resuscitated with 6% hydroxyethyl starch. The features of splenic trauma during hemorrhagic shock or resuscitation were assessed by CEUS, which were compared with the data collected by contrast-enhanced computed tomography (CECT). Acoustic quantification of CEUS was performed to assess splenic blood perfusion in different stages. RESULTS: There was no significant difference in detection rate between CEUS and CECT during hemorrhagic shock and resuscitation. Before hemorrhagic shock, there were 40 traumatic bleeding lesions and 85% of them were revealed by CEUS (34/40). With the progress in shock, CEUS revealed that the numbers of tiny branches of splenic arteries were decreased, which became thinner with no active bleeding. After fluid resuscitation, rebleeding was occurred in 30 traumatic lesions, and 28 (93.3%) of them were captured by CEUS. CEUS could also visualize the changes in splenic perfusion in different stages. During the shock, the arrival time (AT), time to peak intensity (TTP), peak intensity (PI) were significantly lower and the washout time (WT) were significantly higher than those at other stages (P<0.01). CONCLUSION CEUS not only can dynamically monitor the changes in spleen traumatic hemorrhage and recurrent hemorrhage, but also can quantitatively study the changes in spleen blood perfusion in different stages.
Animals ; Contrast Media ; Disease Models, Animal ; Dogs ; Fluid Therapy ; Hemorrhage ; Hydroxyethyl Starch Derivatives ; therapeutic use ; Resuscitation ; Shock, Hemorrhagic ; pathology ; therapy ; Spleen ; diagnostic imaging ; Tomography, X-Ray Computed ; Ultrasonography

Objective To assess the accuracy of ultrasound-guided 16G and 18G core needle biopsy for detecting ultrasound visible breast lesions with different sonographic features. Methods A total of 955 sonographically detected breast lesions examined with ultrasound-guided core needle biopsy (US-CNB) and subsequently surgically excised from July 2005 to July 2012 were retrospectively reviewed. Histological findings of US- CNB and the surgical specimens were analyzed for agreements, sensitivities, false negative rates, and underestimate rates according to different sonographic features. Results The pathological results of the US-CNB showed malignant lesions in 84.1%, high-risk lesions in 8.4%, and benign lesions in 7.5%of the samples. The overall agreement rates were 92.4% for 16G CNB and 92.8% for 18G CNB; their complete sensitivities and false negative rates were both 98.6%and 1.4%, respectively;the high-risk underestimate rates and DCIS underestimate rates were 48.0% and 46.2% for 16G CNB vs 53.3% and 41.2% for 18G CNB, showing no significant difference between the two groups (P>0.01). For both 16G and 18G CNB, the agreements were better for mass lesions than for non-mass lesions (P<0.01). For the mass lesions with a diameter no greater than 10 mm, the agreement rates were lower than the overall data (P<0.01). Calcification in the lesions did not affect the agreement rates (P>0.01). Conclusion Ultrasound-guided 16G and 18G CNB are both accurate methods for evaluating ultrasound visible breast mass lesions with a diameter larger than 10 mm.

Objective To assess the accuracy of ultrasound-guided 16G and 18G core needle biopsy for detecting ultrasound visible breast lesions with different sonographic features. Methods A total of 955 sonographically detected breast lesions examined with ultrasound-guided core needle biopsy (US-CNB) and subsequently surgically excised from July 2005 to July 2012 were retrospectively reviewed. Histological findings of US- CNB and the surgical specimens were analyzed for agreements, sensitivities, false negative rates, and underestimate rates according to different sonographic features. Results The pathological results of the US-CNB showed malignant lesions in 84.1%, high-risk lesions in 8.4%, and benign lesions in 7.5%of the samples. The overall agreement rates were 92.4% for 16G CNB and 92.8% for 18G CNB; their complete sensitivities and false negative rates were both 98.6%and 1.4%, respectively;the high-risk underestimate rates and DCIS underestimate rates were 48.0% and 46.2% for 16G CNB vs 53.3% and 41.2% for 18G CNB, showing no significant difference between the two groups (P>0.01). For both 16G and 18G CNB, the agreements were better for mass lesions than for non-mass lesions (P<0.01). For the mass lesions with a diameter no greater than 10 mm, the agreement rates were lower than the overall data (P<0.01). Calcification in the lesions did not affect the agreement rates (P>0.01). Conclusion Ultrasound-guided 16G and 18G CNB are both accurate methods for evaluating ultrasound visible breast mass lesions with a diameter larger than 10 mm.

Objective To explore a method of establishing a canine model of intracerebral hemorrhage (ICH) by puncturing the main branch of middle cerebral artery (MCA) under ultrasonic guidance and proceed a pilot study of contrast-enhanced ultrasound (CEUS) of ICH.Methods Twelve adult healthy mongrel dogs were enrolled in the experiment.In the condition of bone window,the main branch of MCA was punctured to bleed under the ultrasonic guidance.CEUS of brain was performed every 30 minutes until hematoma formed and another CEUS was performed at 24 hours.Then brains were collected for pathologic examination after dogs were euthanized.Results Eleven of twelve dogs developed ICH successfully that located in the Out edge of basal ganglia,which was confirmed by CEUS and autopsy.One dog died within 6 hours due to intraventricular hemorrhage which was confirmed by autopsy.The hematoma diameters were measured as (22.4 ± 7.1)mm by CEUS before euthanasia and as (21.6 ± 6.9)mm on autopsy.There was no significant difference between the two methods of measurement (t =1.521,P =0.1565).The characteristics of active bleeding and hematoma on ICH were performed in the CEUS imaging.Conclusions A model of dog ICH by puncturing the main branch of MCA under the guidance of ultrasound was established successfully,and it proved to be simple,effective and repeatable.The imaging characteristics of this model are in good accordance with those of ICH in patients.

ObjectiveToexplore the appearance ofmusclecrushinjuryatquantitative ultrasonographic elastography by supersonic shear imaging (SSI).MethodsThe animal experiment was done using a special balloon cuff device to create left hind leg crush injury with a force of 18.6 kPa.Twentythree New Zealand rabbits had crush injury of extremity and survived for 72 hours.SSI quantitative elastography was performed in crushed and no-crushed regions of each rabbit hind leg.Quantitative lesion elasticity was measured in terms of the Young modulus (in kilopascals) at 30 min,2 h,6 h,24 h and 72 h after the release of the crushing pressure.A receiver operating characteristic (ROC) curve analysis was used to assess diagnostic performance.ResultsThe area of crushed region in left hind leg accounted for 2.6％ -3.0％ of body surface area in 23 rabbits.The crushed regions exhibited maximum elasticity values of (19.51 ± 6.74)kPa,(21.47 ± 5.54) Pa,(11.36 ± 5.35)kPa,(15.09 ± 3.31)kPa and (13.72 ± 3.74) kPa,and mean elasticity values of (12.44 ± 3.77)kPa,(13.20 ± 3.60)kPa,(6.80±2.86)kPa,(10.04 ± 2.95)kPa and (6.94 ± 0.97)kPa at 30 min,2 h,6 h,24 h and 72 h after the release of the crushing pressure.Comparing with those of no-crushed regions,they were higher obviously (P＜0.001).ROC curves showed that extremity crush injury was diagnosed by using elasticity value,and the greater the elasticity value,the greater the diagnostic value.Conclusions SSI provides quantitative elasticity measurements,thus adding complementary information that potentially could help in crush injury characterization with conventional ultrasonography.

Objective To analyse the cost-effectiveness analysis of the focal injection treatment under the guidance of contrast enhanced ultrasound(CEUS) for the severe abdominal parenchymal organs trauma.Methods One hundred and twelve patients with severe abdominal parenchymal organs trauma,including 42 hepatic injuries,52 splenic injuries and 33 renal injuries,were rolled in this study. The cost-effectiveness of this group was compared with that of surgery group. Results Treatment duration of single organ trauma under the guidance of CEUS was 20 - 30 minutes. During the first 72 hours after the focal injection, blood pressure and heart rate were improved ( P ＜0.05). Free intraperitoneal liquid did not increase on immediate US image of post-therapy and then it disappeared gradually. Heart rate returned to normal level after injection treatment ( P ＜0. 001 ). Lengths of stay in hospital was 3 - 11 (5.4 ± 2.4)days, which was not different with 3 - 9(5.1± 1.9) of surgery group( P ＞0.05). Treatment cost was 0.32 - 0.43 (0.36 ±0. 14) ten thousand RMB, which was obviously less than 3. 1 - 4. 2 (3.6 ± 10.8) ten thousand RMB of surgery group ( P ＜ 0.01 ). Conclusions The efficacy of the focal injection treatment of the severe abdominal parenchymal organs trauma under the guidance of CEUS was consistent with that of the operative treatment, but its cost was less. Especially it benefited for reserving organs and less pain.

Objective To study feasibility of combined haemostatic percutaneous injection therapy guided by contrast-enhanced ultrasonography (CEUS) in treatment of renal injuries. Methods Eighteen New Zealand rabbits were inflicted with kidney injury imitating grades Ⅲ-Ⅳ blunt injuries. The animals were randomly and equally divided into three groups, Group A ( treated with hemocoagulase),Group B ( treated with hemocoagulase and Alpha-cyanoacrylate) and Group C ( control group, given normal saline). The hemostatic time, hemostatic effect, and perirenal hematoma were observed. Results A perirenal hematoma was observed one hour after treatment. The perirenal fluid thickness was (0.200 ±0.012) cm in Group A, (0.050 ±0.002) cm in Group B and (0.400 ±0.009) cm in Group C, with statistical significance between two test groups and Group C (P ＜ 0.05 ). At days 7 and 14 following treatment, lesion length and cross section was ( 1. 107 ±0. 143) cm and (0.433 ±0. 163) cm in Group A, (0.567 ±0.082) cm and (0. 160 ±0. 078) cm in Group B, and (0.980 ±0. 203) cm and (0.686 ± 0. 157) cm in Group C. There was statistical significance between the test groups (Groups A and B) and Group C (P＜0. 01) at day 14. The lesion size in Group A was lager than that in Group B (P ＜ 0.01 ). One month after treatment, a slight nephrohydrosis occurred in Group B. Conclusions Either injection of simple hemocoagulase or combined use of hemocoagulase and Alpha-cyanoacrylate guided by CEUS can attain positive hemostatic effect, but the latter one is more rapid and reliable.

Objective To approach the diagnostic value of contrast-enhanced ultrasonography(CEUS)for the detection of traumatic laceration of pancreas. Methods Sixty cases of pancreatic traumatic model were made in twelve healthy swines after the animals were anesthetized and laparotomized. Then the conventional ultrasonography(US) and CEUS were performed in each case to diagnose the traumatic region,immediately. The results were compared with surgical findings. Results Among sixty injuries,the detection rate of conventional ultrasonography was 66. 7%,the detection rate of CEUS was 88.3%. Conclusions CEUS shows higher detection rate than conventional US in diagnosing pancreatic laceration,and it also can improve the diagnostic value of ultrasound for the detection of pancreatic laceration.

Objective To explore the value of percutaneous injection of hemostatic agents under the guidance of contrast-enhanced ultrasound(CEUS)for grade Ⅲ-Ⅳ hepatic trauma patients.Methods Eleven patients with severe hepatic trauma were treated using percutaneous focal injection of hemostatic agents.Five of these patients were hepatic injury of grade Ⅲ,and others were grade Ⅳ according to AAST.Results Out of all patients with severe hepatic trauma,9 patients were cured by once percutaneous injection of hemostatic agents under the guidance of CEUS,and 1 patient was cured by twice injection,and 1 patient was switched to surgery because of complicated pancreatic injury and the increase of free intraperitoneal fluid.Conclusions CEUS can display the site and severity of liver injury.Combining with interventional technology,injection of hemostatic agents under the guidance of CEUS can save life and avoid to resect organ,and it can win time for treating other compound injury.

Objective To study haemostatic percutaneous injection therapy for the management of vascular damage in patients with renal injuries guided by contrast-enhanced ultrasonography(CEUS).Methods Which of 56 patients with renal trauma were diagnosis by CEUS,37 cases with grades Ⅱ-Ⅳ renal injuries were brought into our study.According to wound degree and accompanying active bleeding,they were divided into experiment group (percutaneous injection hemostatic treatment)and control group(conservative treatment).Results Thirty-seven renal trauma manifest low perfusion in lesions by CEUS,and the contrast agent could be seen overflow to renal pelvi and the location of capsule in 13 patients.The patients were divided into experiment group(17 cases)and control group(20 cases).The color of hematuria of 9 patients in experiment group became gradually light at 30 mins after treatment.and the color of 7 cases become normal,and hematuria of the only one was iterative appear.The color of hematuria of 9 patients in control group became gradually light in 24-72 hours,others' hematuria became gradually light in 5-14 days.The time of color of hematuria become light of the former was shorter than those of the latter(P<0.05).Reexamination by ultrasound and renal function and urine routine at 1,3 and 6 months after treatment,the results of all patients indicated normal.Conclusions Haemostatic percutaneous injection therapy for renal trauma guided by contrast-enhanced ultrasonography has very obvious hemostatic efficacy.Its advantages included may be used for effective,minimally invasive control of renal injuries(grades Ⅱ-Ⅳ),and can be a feasible management of active bleeding at bedside.