Objective:To explore the value of Plan-Do-Check-Act (PDCA) management model in improving the quality of breast ultrasound diagnosis.Methods:From January 1 to December 31, 2021, patients undergoing breast nodule surgery in the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology were selected for breast ultrasound Breast Imaging Reporting and Data System (BI-RADS) classification diagnosis and follow-up. Using pathological results as the gold standard, the malignant rate of different BI-RADS grade and the coincidence rate of ultrasound diagnosis of breast cancer before the first treatment were analyzed. PDCA cycle management mode was introduced to analyze, learn and sort out the quality of breast ultrasound diagnosis. The same method was used to follow up the breast ultrasound diagnosis in the ultrasound department of our hospital from January 1 to December 31, 2022. The results of two follow-up visits were compared.Results:Compared with 2021, the malignancy rates of category 3 and 4a BI-RADS diagnosed by ultrasonic diagnosis of breast nodules in hospitals in 2022 were closer to the malignancy rates recommended by the classification guidelines of BI-RADS (all P<0.05). There was no significant difference in the malignant rate of BI RADS 4b, 4c and 5 types of nodules (all P>0.05). In 2022, compared with 2021, the ultrasound diagnosis coincidence rate before the first treatment of breast disease increased from 90.4%(1 592/1 761) to 95.9%(1 806/1 884). Conclusions:PDCA management mode is helpful to improve the classification and diagnosis quality of breast ultrasound BI-RADS, and better assist clinical diagnosis and treatment.

Objective:To evaluate the value of ultrasonography in the differential diagnosis of cystic biliary atresia (CBA) and choledochal cyst (CC) in infants.Methods:CBA or CC children <3 months of age diagnosed by surgery in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from 2015 to 2023 were collected, and the differences in general conditions and ultrasound manifestations between CBA group and CC group were retrospectively analyzed.Results:Among the 55 children, 30 were in CBA group and 25 were in CC group. The mean length diameter and width diameter of cysts in the CBA group were about (1.45±1.05)cm and (1.04±0.73)cm, respectively, which were significantly smaller than those in the CC group (5.41±2.98)cm and (3.21±2.90)cm ( P<0.001). The incidence of fibrous plaque (50.0%, 15/30) and abnormal gallbladder morphology (73.3%, 22/30) in the CBA group was significantly higher than that in the CC group [4.0%(1/25) and 16.0%(4/25), respectively]. The incidence of intrahepatic biliary mud deposition (52.0%, 13/25) and intrahepatic biliary duct dilation (64.0%, 16/25) in the CC group was significantly higher than that in the CBA group [0, 3.3%(1/30), respectively]. Conclusions:There are some differences in ultrasonography between CBA and CC children. The length and width of cysts in children with CC are significantly larger than those in children with CBA, and biliary mud deposits or intrahepatic bile duct dilatation are seen in the cysts. The incidence of fibrous plaque and abnormal gallbladder morphology in CBA children is significantly higher than that in CC children.

Objective:To evaluate the renal injury of ultrasound-guided percutaneous fascia dilatation with one-step and multi-step percutaneous renal dilatation on renal injury in pigs.Methods:20 experimental pigs were randomly divided into 16F group and 24F group, with 10 pigs in each group. Under the guidance of ultrasound, the left and right kidneys of each experimental pig in group 16F were expanded by percutaneous renal multi-step expansion and one-step expansion (multi-step dilation subgroup and one-step dilation subgroup respectively) with 16F expander, and the same operation was performed with 24F expander in 24F group. After the operation, the left and right kidneys were left with fistula tubes for 1 week. The duration of hematuria in the renal fistula tubes was observed and compared. One month later, the experimental pigs were killed and the kidneys were removed. The histopathology of each group was observed under the naked eye and microscope. The scar tissue around the nephrostomy channel was removed, and hematoxylin-eosin (HE) and Masson staining were performed respectively. The scar volume was measured by digital image analysis technology, and the percentage of the scar volume in the renal cortex volume was calculated.Results:There was no significant difference in gross hematuria duration between one-step dilation subgroup [(4.60±1.26)d] versus multi-step dilation subgroup [(4.70±1.17)d] of 16F group ( P>0.05); There was no significant difference in gross hematuria duration between one-step dilation subgroup [(5.40±1.25)d] versus multi-step dilation subgroup [(5.50±1.08)d] of the 24F group ( P>0.05). There was no significant difference in the gross and histological observation of pig kidney specimens in 16F group and 24F group. There was no significant difference in the scar volume of the fistula channel [(0.35±0.04)cm 3, (0.36±0.03)cm 3] and its percentage in the whole renal cortical volume [(0.41±0.05)%, (0.41±0.06)%] between one-step dilation subgroup versus multi-step dilation subgroup of 16F group (all P>0.05); there was no significant difference in the scar volume of the fistula channel [(0.48±0.02)cm 3, (0.49±0.04)cm 3] and its percentage in the whole renal cortical volume [(0.52±0.04)%, (0.53±0.07)%] between one-step dilation subgroup versus multi-step dilation subgroup of 24F group (all P>0.05). The scar volume and its percentage in the whole renal cortical volume of the one-step dilation subgroup and the multi-step dilation subgroup in the 24F group were higher than that of the 16F group, with statistically significant difference (all P<0.05). Conclusions:Both one-step and multi-step percutaneous renal dilatation have less damage to renal parenchyma. The multi-step dilatation has no obvious advantage over one-step dilatation in reducing renal parenchyma injury.

Objective:To explore the diagnostic value of high frequency ultrasound in the diagnosis of closed penile cavernous rupture.Methods:The ultrasonic examination data of 8 patients with closed penile cavernous rupture treated in Union Medical College Affiliated to Tongji Medical College of Huazhong University of Science and Technology from August 2016 to May 2021 were retrospectively analyzed, and the high-frequency ultrasonic image features were analyzed.Results:Among the 8 patients with closed penile cavernous rupture, 6 were located at the distal end of the corpus cavernosum, one was located at the middle of the corpus cavernosum, and one was located at the proximal end of the corpus cavernosum. All of them were unilateral penile cavernosum rupture, 3 on the left side and 5 on the right side. In all 8 cases, the white membrane of the corpus cavernosum of the penis was continuously interrupted, and the broken end could be clearly displayed. The largest white membrane breach was 16.1 mm, and the smallest was 2.1 mm. Hematoma formed around the rupture of the tunica albuginea of the penis corpus cavernosum, and the maximum range of hematoma was 40.3 mm×15.4 mm, the minimum range of hematoma was 7.9 mm×5.6 mm.Conclusions:High frequency ultrasound is convenient, rapid and accurate, and can be used as the first choice of auxiliary examination for closed penile cavernous rupture.

In recent years, ultrasound elastography, as a new technique for evaluating soft tissue elasticity, has been progressively used in musculoskeletal system. Shear-wave elastography (SWE) is considered to be more objective, quantitative, and reproducible than other ultrasonic elastography techniques with increasing applications to the musculoskeletal system. A number of studies have shown that SWE has high application value in determining severity and prognosis of the musculoskeletal tissue diseases (including tendons, muscles, nerves and ligaments). This article describes the applications of SWE in the evaluation of musculoskeletal system.

Objective:To investigate the ultrasonographic features of internal jugular venous vein pseudo-aneurysm.Methods:The ultrasonographic and clinical features of a patient with internal jugular venous vein pseudo-aneurysm in Union Hospital Affiliated to Huazhong University of Science and Technology were retrospectively analyzed. These characteristics of this patient combined with cases from literatures were summarized.Results:Ultrasound showed that the 38.6 mm×14.0 mm×29.9 mm anechoic area in the soft tissue layer of the left neck communicated with the left internal jugular vein through the 3.8 mm wide breach, and a 12.9 mm×6.6 mm slightly hyperechoic mass was found in the anechoic area. Color Doppler flow imaging showed that the internal jugular vein communicated with the anechoic area through the crevasse. There was no obvious blood flow signal in slightly hyperechoic mass. The bidirectional burr-like blood flow signal could be detected by pulse-wave Doppler. Contrast enhanced ultrasound showed that the contrast agent flowed into the mass from the internal jugular vein through the breach, and the slightly hyperechoic mass appeared the contrast filling defect, and contrast agent was well filled in the rest of the anechoic area. Ultrasound diagnosis: left internal jugular vein pseudoaneurysm with thrombosis. 35 cases of cervical vein pseudo-aneurysm patients were finally included in 23 documents, including 12 males, 23 females, 15 cases on the left side, 20 cases on the right side, 6 cases of the internal jugular vein, 27 cases of the external jugular vein; one case only describes the neck veins and supraclavicular vein in another one case. Among them, 34 cases showed subcutaneous anechoic masses on ultrasound, 1 case showed slightly hyperechoic masses, and 35 cases showed venous wall breaches.Conclusions:Ultrasound examination has high diagnostic value for vein pseudo-aneurysm owing to its convenience, fast and serial observation. Therefore, it is the preferred method and can be widely used in clinical practice. Contrast-enhanced ultrasound can clearly show the blood perfusion, and help to improve the diagnostic confidence of the operator.

Objective: To prepare a kind of lipid nanoparticle ultrasound contrast agents with the ability to target to viable myocardium for diagnosis. Methods: The agent was a biotinylated, fluorescent-labelled, lipid-coated, liquid perfluorocarbon emulsion. Physico-chemical properties of the agent were measured, including size distribution, Zeta Potential, concentration and so on. Ischemia-reperfusion models were created in rats, and then exposed to biotinylated anti-MCP-1 monoclonal antibody, rhodamine avidin and biotinylated, FITC-labelled nanoparticles, respectively. Echocardiography was taken before and after injection. Frozen sections of their hearts were observed under fluorescence microscope. Results: The particle diameter, zeta potential and concentration of lipid nanoparticles were (172.30±52.06)nm, (-33.10±6.50)mV and (2.28±0.46)×10¹¹/ml, respectively. From the short-axis view, the myocardium under endocardium of anterior wall was enhanced obviously. While myocardium of other walls were still. The lipid nanoparticles located in the myocardium of anterior wall and gave out bright green and red fluorescence under fluorescence microscope, while neither lipid nanoparticles nor fluorescence were found in other sites of ventricular myocardium. Conclusions The viable myocardium can be targeted and acoustically enhanced by the self-made nano-scale ultrasound contrast agent. This new agent has potential to improve sensitivity and specificity for noninvasive identifying viable myocardium.

Objective This study aimed to discuss the performance and impact factors of shear wave elastography (SWE) for differential diagnosis of thyroid nodules (TN).Methods 84 TNs were included in the study.The SWE indices of Emax,Emin and Emean for the region-of-interest were calculated and analyzed.All TNs were divided into subgroups (＜ 10.0 mm group and ＞ 10.0 mm group) according to the size and whether it has calcification (calcification group and non-calcification group).We compared the elasticity indices between subgroups and analyzed the diagnostic performance of SWE with different impact factors.Results There were 40 benign TNs and 44 malignant TNs.The Emean and Emax of malignant TNs were significant higher than those of benign TNs (P =0.000).Both the Emean and Emax of were significant higher in TNs with presence of calcification (P =0.036,P =0.031).The receiver operator characteristic (ROC) curve showed that the diagnostic sensitivity was 94.7％ in the ＞ 10.0 mm group with Emean ＞ 19.6 kPa as the cut-off value,and 92.9％ in non-calcification group with Emean ＞21.1 kPa as the cut-off value.Conclusions The elastic modulus of malignant TNs was significant higher than benign TNs.The presence of calcification may increase the stiffness of TNs.The diagnostic performance of SWE was better in TNs with those sizes ＞ 10 mm and TNs with absence of calcification.

Objective To investigate the clinical value of lung ultrasound (LUS) in the diagnosis of infectious pneumonia in premature infant.Methods 20 premature infants with infective pneumonia were selected and examined by high-frequency ultrasound.The results were compared with chest X-ray data.Pulmonary ultrasound was monitored on the 3rd to 5th,8th to 10th days of treatment and before discharge.The total number and maximum depth of pulmonary consolidation were calculated and the changes of the above parameters with the progression of pulmonary diseases were compared.Results The LUS imaging of 20 cases showed:A-line disappearance and pulmonary interstitial syndrome (100％),lung consolidation (95％),abnormal pleural lines (55％),interstitial syndrome (100％) and pleural effusion (15％).The X-ray of 20 cases showed:increased lung texture(100％),patchy blurred glass shadow (40％),lung consolidation(40％).The maximum depth of lung consolidation and the total number of lung consolidation involving rib clearance are decreased after therapy.Conclusions LUS is of great value in diagnosis and monitor the progresses of infectious pneumonia in premature infant,and can be used as the preferred diagnostic method in imaging.

Objective The purpose of this study was to produce cut-off values of fetal pulmonary artery stenosis (PS),allowing the application of Z-scores to evaluate fetal pulmonary artery.Methods A total of 214 normal singleton fetuses and 107 singleton fetuses with PS were included in this study.They were measured for standard biometry:biparietal diameter (BPD) and femoral diaphysis length (FL) and an assessment of gestation age (GA).The standardized fetal echocardiographic measurements included diameters of pulmonary valve annulus (PV),pulmonary artery (PA),ductus arteriosus (DA) and aorta (AO).Then we calculated the Z-scores from parameters of fetal size.The Z-scores differences of PV,PA,DA and AO in PS group were compared.The receiver operator characteristic (ROC) curves of PV and PA Z-scores were obtained by statistical analysis.Results Compared with the normal group,the Z-scores of PV,PA and DA decreased in the PS group,whereas the Z-scores of AO increased (P ＜0.01 for all).The critical values of Z-score for PV in diagnosing PS with BPD,FL and GA as variables were-1.13,-1.33,-1.28,with sensitivity 94.2％,90.3％,93.5％,specificity 60.0％,65.0％,62.5％,respectively.The critical values of Z-score for PA with BPD,FL and GA as variables were-1.01,-0.98,-1.01,with sensitivity 96.8％,96.8％,96.1％,specificity 65.0％,65.0％,62.5％,respectively.Conclusions In the fetus with pulmonary artery stenosis,PV,PA and DA Z-scores decreased,while AO Z-scores increased.The pulmonary artery Z-scores had important application value in quantitative evaluation and diagnosis of mild fetal pulmonary artery stenosis.