Objective: To investigate the current basic situation of ultrasound machines of ultrasound departments in Shanghai medical institutions, and to provide the basis for making management policy in order to promote medical quality. Methods: Questionnaire surveys about ultrasound machines and service ability including producing countries of ultrasound machines, the number of ultrasound machines, using years of ultrasound machines, yearly workload and the yearly number of patients that each ultrasound machine accepted were made in 2013 and 2018, respectively. Statistical results were compared between the two surveys. Results: Compared with 2013, the share of imported ultrasound machines declined in 2018 (82% vs 91%). Compared with 2013, the number of ultrasound machines in Shanghai medical institutions had increased by 31% in 2018 (2 123 vs 1 617). The occupancy rate of ultrasound machines in tertiary hospitals was the highest (tertiary hospitals 40%, secondary hospitals 25%, primary grade hospitals 20%, and private hospitals 15%). Compared with 2013, the proportion of ultrasound machines that have been used for more than 10 years increased (9% vs 4%), the yearly workload of ultrasound examination had increased by 46% (19.82 million person-time vs 13.59 million person-time). Tertiary hospitals bored the highest proportion of the workload (tertiary hospitals 51%, secondary hospitals 35%, primary grade hospitals 4%, and private hospitals 10%). Currently, the number of ultrasound machines per 10, 000 people in Shanghai was 1.14. The yearly number of patients that each ultrasound machine accepted had increased by 11% (9300 person-time vs 8400 person-time in 2018). Conclusions The scale of ultrasound departments in Shanghai medical institutions has been developing. Brand localization of ultrasound machines is improving. However, the renewal ability of ultrasound machines still needs to be improved. The workload of ultrasound department is getting heavier. Hierarchical diagnosis and treatment is unbalanced.

Objective To assess the deep inferior epigastric perforator (DIEP) vessels in patients with breast reconstruction flaps by contrast-enhanced ultrasound (CEUS) and three-dimensional ultrasound (3DUS) reconstruction techniques.Methods Conventional ultrasound,CEUS and 3DUS were used to evaluate DIEP vessels of breast reconstruction flaps in 43 patients before surgical procedures.The identification,localization and spatial relationship of DIEP vessels were analyzed with conventional ultrasound,CEUS and 3DUS methods.The findings of CEUS and 3DUS were compared to conventional ultrasound and surgical outcome.Results Compared to CDFI,40 cases (93％) were observed more clearly with CEUS,and were showed more accurately than conventional ultrasound.41 cases (95％) could be displayed wonderfully in 3D ultrasound.Perforators which were detected by ultrasound were confirmed in the surgery and the transferred flaps survived completely.Conclusions Perforators can be displayed more clearly and located more accurately by CEUS and 3DUS.CEUS and 3DUS could play a very important role in the preoperative navigation of the DIEP than conventional ultrasound.

Objective To evaluate the value of quantitative analysis of real-time elastosonography in the differential diagnosis of benign and malignant thyroid nodules. Methods The elastograms of eight-six patients with 98 thyroid nodules were observed. The strain ratio of each lesion and the averages of those of benignancy and malignancy were calculated. With the ROC curve, the critical point of the strain ratio of different lesions was gotten. All the lesions were confirmed with surgery and pathologic examination. Results The average of strain ratio of benign nodules was 2. 18,while that of malignancy was 8. 48. The strain ratio of benign and malignant lesions were of significant difference statistically (P <0.05). According to ROC curve, the critical point of strain ratio between benign and malignant lesions was 3. 3. Conclusions The quantitative analysis of real-time elastosonography is a newly valuable technique of ultrasonography which is helpful in the differential diagnosis of thyroid lesions.

Objective To evaluate the feasibility of virtual touch tissues quantification (VTQ) technique in the assessment of liver fibrosis and to find the suitable measuring position of VTQ. Methods Liver stiffness was measured with Acuson S2000 ultrasound system in totally 533 subjects including healthy people ( n = 302), patients with hepatitis B virus(HBV) ( n = 191) and patients with fatty liver ( n =40). Each subject received VTQ measurements in four parts (superficial and deep parts of right lobe, and superficial and deep parts of left lobe) and every part was measured five times to get five values. The reproducibility of different part of VTQ was analyzed with intraclass correlation coefficient (ICC). Results The achievement rate was high in both right and left lobes,especially in right lobe. The lowest rate was from the deep part of left lobe. Except deep part of left hepatic lobe in fatty liver,all parts of liver in all groups of patients were with ICC higher than 0. 75. In deep part of right lobe, VTQ values were (1.12 ± 0. 19)m/s in control group subjects, (1.83 ± 0. 62)m/s in patients with hepatitis B virus and (1.05 ± 0. 25)m/s in patients with fatty liver. There was significant difference of VTQ value between control group and patients with HBV ( P = 0.000), also between patients with HBV and patients with fatty liver ( P = 0.000). Conclusions It is stable to measure liver stiffness with VTQ technique, which is a new method to evaluate liver stiffness noninvasively. Right hepatic lobe is the most suitable position to be measured.

Objective To establish the reference value of liver virtual touch tissues quantification (VTQ) values in healthy subjects. Methods Liver stiffness was measured with Siemens Acuson S2000 ultrasound system in totally 300 healthy subjects. The first one hundred healthy subjects received VTQ measurements in four parts (superficial and deep parts of right lobe, superficial and deep parts of left lobe). Then the achievement rate in different part of liver was calculated to choose the suitable measuring position. On the other hand, the reproducibility was analyzed with intraclass correlation coefficient (ICC). The last two hundred healthy subjects received VTQ measurements in the suitable position only. The reference value of VTQ was calculated using (x-)±1.96s. Results It was stable to measure liver stiffness with VTQ technique. The achievement rate was high in right lobe, and the deep parts of right lobe was the best measuring position. There was significant difference of VTQ value between males and females (P＜0.001), while the VTQ value was similar in different age groups. The reference value was 0.79-1.57 m/s in males and 0.74-1.40 m/s in females. Conclusion Liver VTQ value in healthy subjects are different between males and females.

Objective To make certain about the phase of time from the culminated point of instantaneous accelerating wave intensity (W1) to that of instantaneous decelerating wave intensity (W2) wave intensity(WI) technique. Methods The ejection time of the curve of Doppler rate of flow in aortic opens and W1～W2 of common carotid arteries of both sides were detected in 66 healthy adults by Prosound α10 color Doppler ultrasound and the data were contrasted and analyzed. Results There were no statistical significances in the standardized value difference of ejection time of aorta and of time from starting point of W1 to culminated point of W2 in common carotid arteries of both sides (P>0.05). And there were all statistical significances in the standardized value difference of ejection time of aorta and of time in other groups (P<0. 001). Conclusions The ejection time is the time from starting point of W1 to culminated point of W2. The beginning of cardiac ejection should be the starting point of W1 curve,and the culminated point of W2 is the terminal time of ejection.

Objective To evalute the clinical application of the new technique of instantaneous wave intensity(WI) through the correlative analysis of instantaneous acceleration wave intensity(W1) and Tei index. Methods The correlation of the intensity of W1 (the apogee of W1) and Tei index of 66 healthy adults were analyzed by Prosound a10 color Doppler ultrasonograph. Results There were positive correlations in pressure and caliber between the common carotid arteries of both sides in 66 cases of healthy adults (P <0.01). There were negative correlations respectively between the pressure of W1 of left and right common carotid arteries and Tei index (P <0.05),and there were the same in caliber (P <0.01), mean pressure (P <0.05) and mean caliber (P <0.01). Conclusions W1 is negatively correlated with Tei index and can be an index in judging the systolic function.

Objective To explore the generalization and application of R-W1 through the phase analysis of Wave intensity technique.Methods The phases of R-W1 of 66 healthy adults were detected by Aloka Prosound α10 color Doppler uhrasound.Results There were all statistical significances in the time difference of R-W1 in left and right common carotid arteries and right brachial artery(P＜0.01),in the pressure wave conductive time in left and right common carotid arteries(P＜0.05),in right brachial artery and both sides of common carotid arteries(P＜0.01).There were no statistical significances in the time from the starting point to the culminate point of W1 in left and right common carotid arteries.There were statistical significances in the time from the starting point to the culminate point of W1 in right brachial artery and both sides of common carotid arteries(P＜0.05).Conclusions"R-W1 almost equals to pre-ejection period"as reported by literatures actually involves three phases which respectively are isovolumetric contraction time of left ventricle,pressure wave conductive time and time from the starting point to the culminate point of W1.The factor of pressure wave conductive time should be considered when evaluating diseases in clinic.The pre-ejection time should be the time from the culminate point of R wave in ECG to the starting point of W1 and the time from the starting point to the culminate point of W1 should not be involved in.

Objective To investigate the feasibility of contrast-enhanced ultrasonography(CEUS) in quantitative assessment of angiogenesis in patients with hepatocellular carcinoma(HCC).Methods Thirtythree patients with HCCs confirmed by pathology underwent CEUS in one week preoperatively.The presets and contrast dosage were fixed in all the studies.The new quantitative software with GAMMA fitting technique was used to analyze the dynamic images offline.The quantitative parameters such as baseline intensity,increased signal intensity(ASI),decent curvature(a2),up slope rate(a3),arrive time(AT), time to peak(TTP), accelerate time(ACT),peak intensity(PI),and area under curve(AREA) were calculated.The pathological specimen was stained with CD34 antibady and microvessel density (MVD) was calculated automatically.The correlation between parameters of CEUS and MVD was analyzed statistically.Results The parameters of ASI, a2, a3, AT, TTP, PI and ACT in the tumor were significantly different from those in liver parenehyma ( P＜0.01 ).The value of a2 in the tumor was correlated with MVD, the standardized ASI and AREA were correlated with MVD (P＜0.05).Conclusions The quantitative analysis with CEUS reflects the microvascular perfusion flow objectively.It provides a noninvasive imaging method to assess the angiogenesis in HCCs.

Objective To assess the value of ultrasonography(US)in the diagnosis of pancreas endocrine tumors(PET).Methods Thirty-six patients with PET confirmed by surgery and pathology were retrospectively reviewed.Results There were 37 PET in 36 patients,among which 33 tumors in 32 cases were detected bv US,four tumors were missed on US and the detection rate was 88.9%(32/36).The tumor size was 1.0 cm×0.8 cm～12.9 cm× 11.3 cm.Among 12 cases of equal to or less than 2 cm,9 tumors were detected and the detection rate was 75.0%.PET presented mostly hypoechogenicity(78.8%),other 7 cases presented mixed-echogenicity.Color Doppler US was performed on 12 cases and 11 tumors showed color blood signals.Abundant flow signal was detected in 8 tumors(66.7%).PET were found in pancreatic head (n=11),neck(n=2),body(n=6)and tail(n=11),which was diagnosed correctly in 30 cases (81.1%).Conclusions US is a useful tool in the detection and diagnosis of PET.