Objective: To evaluate the efficacy, feasibility and safety of contrast-enhanced CT-guided core biopsy of retroperitoneal masses. Materials and Methods: Contrast-enhanced CT-guided biopsy of retroperitoneal masses was...Objective: To evaluate the efficacy, feasibility and safety of contrast-enhanced CT-guided core biopsy of retroperitoneal masses. Materials and Methods: Contrast-enhanced CT-guided biopsy of retroperitoneal masses was performed in 26 patients. Histopathological diagnosis was obtained and accuracy was calculated. Two blinded radiologists determined feasibility of biopsy procedures on routine CT-guidance, and compared accessibility of target lesions using contrast-enhanced and non-contrast-enhanced CT. Results: Satisfactory samples were obtained in all 26 patients and pathological diagnosis was made in 24. Accuracy was 95.5%. Routine CT-guided biopsy punctures were not satisfaction in 4/26 patients, and contrast-enhanced CT scans rendered the target lesions more accessible in 16 patients. Conclusion: Contrast-enhanced CT-guided biopsy increases the feasibility of biopsy of retroperitoneal masses.展开更多
Objective: To discuss the correlation of contrast-enhanced CT quantitative parameters with proliferation and invasion gene expression in pancreatic cancer. Methods: A total of 100 patients with pancreatic cancer who w...Objective: To discuss the correlation of contrast-enhanced CT quantitative parameters with proliferation and invasion gene expression in pancreatic cancer. Methods: A total of 100 patients with pancreatic cancer who were treated in the hospital between May 2015 and May 2017 were selected as pancreatic cancer group, and 48 patients with necrotic pancreatitis who received surgical treatment in the hospital during the same period were selected as pancreatitis group. Differences in pancreatic contrast-enhanced CT value as well as the expression of proliferation-related genes and invasion-related genes in lesion tissue were compared between the two groups, and Pearson test was used to evaluate the correlation of pancreatic cancer tissue CT value with proliferation and invasion gene expression. Results: Contrast-enhanced CT value of pancreatic cancer tissue was lower than that of pancreatitis tissue;proliferation-related genes Bmi-1, Ezrin and FOXC1 mRNA expression in lesion tissue of pancreatic cancer group were higher than those of pancreatitis group while EphB2 and RGC-32 mRNA expression were lower than those of pancreatitis group;invasion-related genes FHL1, JDP2, Let-7f and TFPI-2 mRNA expression in lesion tissue of pancreatic cancer group were lower than those of pancreatitis group while Twist and HOXB7 mRNA expression were higher than those of pancreatitis group. Pearson test showed that the contrast-enhanced CT value of pancreatic cancer was directly correlated with the proliferation and invasion gene expression in lesion tissue. Conclusion: Contrast-enhanced CT value of pancreatic cancer tissue was lower than that of normal pancreas tissue, and the specific CT value was directly correlated with the tumor proliferation and invasion-related gene expression, and can be used as a simple and reliable method for early diagnosis of disease and judgement of illness severity.展开更多
Purpose: The purpose of this study was to retrospectively assess the detectability and enhancement pattern of rectal carcinoid tumors on contrast-enhanced computed tomography colonography (CE-CTC). Methods: The study ...Purpose: The purpose of this study was to retrospectively assess the detectability and enhancement pattern of rectal carcinoid tumors on contrast-enhanced computed tomography colonography (CE-CTC). Methods: The study sample consisted of 12 lesions in nine patients of rectal carcinoid tumors. To evaluate the detectability, two radiologists reviewed axial and 3D images including air enema (AE), virtual endoscopy (VE), and virtual colon dissection (VCD). To determine the contrast enhancement pattern of the tumors, the CT attenuation value of each lesion was measured in three phases. Results: Four of the 12 lesions (33%) were detected on axial images in patients in both the prone and supine positions, the sizes of which were 6 mm or larger. Seven lesions (58%), including the four lesions mentioned above, were detected on 3D images including AE and VE in patients in the prone position, the sizes of which were 5 mm or larger. The ranges of CT attenuation values of the lesions at 40 s, 70 s and 240 s were 112 - 147, 116 - 140 and 82 - 97 HU, respectively. Conclusion: Rectal carcinoid tumors are challenging to detect on CE-CTC. They demonstrated enhancement at the early phase and washout at the delayed phase on CE-CTC.展开更多
Objective: to analyze the role of dynamic magnetic resonance enhancement in imaging diagnosis of early hepatocellular carcinoma. Methods: sixty-two patients with hepatocytic lesions who were enrolled in our hospital f...Objective: to analyze the role of dynamic magnetic resonance enhancement in imaging diagnosis of early hepatocellular carcinoma. Methods: sixty-two patients with hepatocytic lesions who were enrolled in our hospital from June 2019 to June 2020 were selected as the research subjects. All patients were examined by dynamic enhanced CT scan and liver MRI. The diagnostic results of the two different methods were analyzed based on pathological examination, and their diagnostic value was compared. Conclusion: liver MRI examination in patients with HCC has relatively high sensitivity and specificity, and excellent application effect, which can provide accurate basis for early diagnosis and later targeted treatment by doctors, and is worthy of clinical application and vigorous promotion.展开更多
Objective Primary liver cancer,predominantly hepatocellular carcinoma(HCC),is a significant global health issue,ranking as the sixth most diagnosed cancer and the third leading cause of cancer-related mortality.Accura...Objective Primary liver cancer,predominantly hepatocellular carcinoma(HCC),is a significant global health issue,ranking as the sixth most diagnosed cancer and the third leading cause of cancer-related mortality.Accurate and early diagnosis of HCC is crucial for effective treatment,as HCC and non-HCC malignancies like intrahepatic cholangiocarcinoma(ICC)exhibit different prognoses and treatment responses.Traditional diagnostic methods,including liver biopsy and contrast-enhanced ultrasound(CEUS),face limitations in applicability and objectivity.The primary objective of this study was to develop an advanced,lightweighted classification network capable of distinguishing HCC from other non-HCC malignancies by leveraging the automatic analysis of brightness changes in CEUS images.The ultimate goal was to create a user-friendly and cost-efficient computer-aided diagnostic tool that could assist radiologists in making more accurate and efficient clinical decisions.Methods This retrospective study encompassed a total of 161 patients,comprising 131 diagnosed with HCC and 30 with non-HCC malignancies.To achieve accurate tumor detection,the YOLOX network was employed to identify the region of interest(ROI)on both B-mode ultrasound and CEUS images.A custom-developed algorithm was then utilized to extract brightness change curves from the tumor and adjacent liver parenchyma regions within the CEUS images.These curves provided critical data for the subsequent analysis and classification process.To analyze the extracted brightness change curves and classify the malignancies,we developed and compared several models.These included one-dimensional convolutional neural networks(1D-ResNet,1D-ConvNeXt,and 1D-CNN),as well as traditional machine-learning methods such as support vector machine(SVM),ensemble learning(EL),k-nearest neighbor(KNN),and decision tree(DT).The diagnostic performance of each method in distinguishing HCC from non-HCC malignancies was rigorously evaluated using four key metrics:area under the receiver operating characteristic(AUC),accuracy(ACC),sensitivity(SE),and specificity(SP).Results The evaluation of the machine-learning methods revealed AUC values of 0.70 for SVM,0.56 for ensemble learning,0.63 for KNN,and 0.72 for the decision tree.These results indicated moderate to fair performance in classifying the malignancies based on the brightness change curves.In contrast,the deep learning models demonstrated significantly higher AUCs,with 1D-ResNet achieving an AUC of 0.72,1D-ConvNeXt reaching 0.82,and 1D-CNN obtaining the highest AUC of 0.84.Moreover,under the five-fold cross-validation scheme,the 1D-CNN model outperformed other models in both accuracy and specificity.Specifically,it achieved accuracy improvements of 3.8%to 10.0%and specificity enhancements of 6.6%to 43.3%over competing approaches.The superior performance of the 1D-CNN model highlighted its potential as a powerful tool for accurate classification.Conclusion The 1D-CNN model proved to be the most effective in differentiating HCC from non-HCC malignancies,surpassing both traditional machine-learning methods and other deep learning models.This study successfully developed a user-friendly and cost-efficient computer-aided diagnostic solution that would significantly enhances radiologists’diagnostic capabilities.By improving the accuracy and efficiency of clinical decision-making,this tool has the potential to positively impact patient care and outcomes.Future work may focus on further refining the model and exploring its integration with multimodal ultrasound data to maximize its accuracy and applicability.展开更多
Background and aims:Contrast-enhanced ultrasound(CEUS)is widely used in the diagnosis of complications after liver transplantation.This study compared the diagnostic efficacy of CEUS with that of contrast-enhanced com...Background and aims:Contrast-enhanced ultrasound(CEUS)is widely used in the diagnosis of complications after liver transplantation.This study compared the diagnostic efficacy of CEUS with that of contrast-enhanced computed tomography(CECT)for focal liver lesions in liver transplant recipients.Methods:We retrospectively reviewed 115 liver transplant recipients who were diagnosed to have focal liver lesions at our hospital between June 2015 and June 2023.All patients were examined by CEUS and CECT and had a definitive pathological diagnosis.Based on the diagnostic outcomes,the sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of these imaging modalities in differentiating between benign and malignant lesions were calculated using a four-table method.Differences in diagnostic efficacy between CEUS and CECT with respect to pathological findings were compared using the chi-squared test and Fisher's exact test.The consistency of diagnosis between these modalities was assessed using the linear weighted kappa test.Results:CEUS identified 79 malignant and 36 benign lesions,while CECT detected 81 malignant and 34 benign lesions.The sensitivity,specificity,positive predictive value,negative predictive value,and overall accuracy of CEUS and CECT in diagnosis of focal lesions in transplanted livers were 95.7%vs 97.2%,97.2%vs 96.1%,97.9%vs 97.5%,97.2%vs 98.6%,and 96.4%vs 97.1%,respectively.Both CEUS and CECT demonstrated comparable diagnostic efficacy(κ¼0.899).CEUS showed strong diagnostic consistency with pathological results(κ¼0.912)and was more effective than CECT in diagnosing focal normal liver tissue and fat infiltration(p<0.05).Both methods were equally effective for diagnosis of focal inflammatory lesions,infarction,and hemangioma.Conclusion:CEUS is as effective as CECT for diagnosis of benign and malignant lesions in transplanted livers but surpasses CECT in differentiating benign lesions,particularly focal normal liver tissue and fat infiltration.展开更多
This editorial comments on Yang et al’s article that reported a correlation between dynamic contrast-enhanced ultrasound(CEUS)quantitative parameters and Ki67/tumor differentiation.The validation of CEUS as a diagnos...This editorial comments on Yang et al’s article that reported a correlation between dynamic contrast-enhanced ultrasound(CEUS)quantitative parameters and Ki67/tumor differentiation.The validation of CEUS as a diagnostic modality in this study deserves merit.However,it raises interesting points of discussion:(1)Since pancreatic cancer is an overarching term that includes conventional pancreatic ductal adenocarcinoma(PDAC),other subtypes,and neuroendocrine neoplasms(NENs),the inclusion/exclusion criteria require better clarification;(2)Most PDACs are grade 1-2 which contrasts with Yang et al’s study where 46%were grade 3;(3)Ki67 is officially recognized for grading NENs,but not for PDAC;(4)Hotspots are selected for the Ki67 grading of NENs.However,for other tumors(e.g.,breast carcinoma),the average count or hotspots are used;(5)There is no agreement for defining high-grade Ki67 cut-off for non-NENs;reports range from 10%to 50%;and(6)Ki67 reflects cellular proliferation but is not always the most important indicator for biologic aggressiveness.That notwithstanding,since the ratification of Ki67 for prognosis in NENs was based on survival outcomes,the real gold standard should be survival,instead of using Ki67 as a surrogate gold standard.In conclusion,the validation of CEUS parameters for PDAC is a work in progress.CEUS is valuable in assessing PDAC but should be viewed as augmenting other modalities such as computed tomography,magnetic resonance imaging,positron emission tomography and endoscopic ultrasound.展开更多
Liver transplantation is the primary therapeutic choice for end-stage liver disease.Currently,biliary complications are among the main factors affecting the survival rate and quality of life of liver transplant recipi...Liver transplantation is the primary therapeutic choice for end-stage liver disease.Currently,biliary complications are among the main factors affecting the survival rate and quality of life of liver transplant recipients.Nevertheless,the clinical manifestations of biliary complications following liver transplantation are often non-specific,making early diagnosis and timely treatment crucial for improving patient outcomes.Ultrasound is the preferred imaging method following liver transplantation.Importantly,contrast-enhanced ultrasound,with the adminis-tration of contrast agents,can improve the resolution of biliary images and enable real-time,dynamic visualization of microcirculation perfusion in the biliary system and surrounding tissues.The present article describes the normal ultra-sonic features of the biliary system following liver transplantation and briefly reviews the progress in the ultrasonic diagnosis of common biliary complications,including anastomotic biliary strictures,non-anastomotic biliary strictures,biliary leakage,biloma,and bile sludge/bile stone.展开更多
Background:This study evaluates the efficacy of gabexate mesylate thermosensitive in-situ gel(GMTI) in the treatment of beagle grade Ⅲ pancreatic trauma(PT) with the assistance of contrast-enhanced ultrasound(CEUS) a...Background:This study evaluates the efficacy of gabexate mesylate thermosensitive in-situ gel(GMTI) in the treatment of beagle grade Ⅲ pancreatic trauma(PT) with the assistance of contrast-enhanced ultrasound(CEUS) and investigates its mechanism of action.Methods:A grade Ⅲ PT model consisting of 15 beagle dogs with severed main pancreatic ducts was created and treated with cephalic vein injection of gabexate mesylate(GM)(1.54mL/10kg,TID) and peripancreatic injection of GMTI(4.63 mL/10 kg,QD) guided by CEUS within 24h post-surgery.Ascites and serum levels of amylase(AMY),lipase(LPS),C-reactive protein(CRP),interleukin(IL)-6,tumor necrosis factor(TNF)-α,and urinary trypsinogen activating peptide(TAP) were detected by ELISA.Histopathological changes in the canine pancreas were observed by Hematoxylin and Eosin staining.Results:CEUS accurately displayed pancreatic lesions and guided catheterisation.Compared to the control group,the ascites was significantly reduced after treatment(p<0.01).AMY and LPS ascites significantly decreased on post-operative 1st and 2nd day(p<0.01).The levels of AMY,LPS,CRP,IL-6,and TNF-α in serum were decreased(p<0.05 or p <0.01).Urinary TAP was decreased 1 and 2 days after treatment(p<0.05or p<0.01,respectively).In the control group,pancreatic tissue necrosis was evident in the wound area.Normal glandular cell structures and fibrous tissue hyperplasia were observed in the wound area after GMTI treatment.The GMTI group performed better than the GM group in improving pancreatic histology and reducing AMY levels in the early post-operative period.Conclusion:Guided by CEUS,daily peripancreatic injections of GMTI in Beagles effectively inhibit pancreatic enzyme activity and aid in the adjuvant treatment of pancreatic trauma.展开更多
BACKGROUND The expression level of Ki-67 and the degree of differentiation in pancreatic cancer determine tumor aggressiveness and patient prognosis,which holds significant implications for clinical decision-making.A ...BACKGROUND The expression level of Ki-67 and the degree of differentiation in pancreatic cancer determine tumor aggressiveness and patient prognosis,which holds significant implications for clinical decision-making.A major challenge in preoperative pancreatic ductal adenocarcinoma management is predicting tumor malignancy.Contrast-enhanced ultrasound(CEUS),a dynamic imaging technique based on blood pool visualization,can reveal lesion vasculature and provide quantitative perfusion data reflecting angiogenesis.By tracking contrast agent kinetics,CEUS offers non-invasive insights into tumor vascularization,helping assess malig-nancy potential.AIM To investigate the correlation between Ki-67 and pancreatic cancer differentiation using CEUS quantitative parameters and evaluated their diagnostic accuracy.METHODS This retrospective study analyzed pancreatic cancer patients who underwent CEUS and pathological confirmation.Pathological differentiation,clinical data,and quantitative CEUS parameters[maximum intensity(IMAX),rise time(RT),rise slope 50%(Rs50),rise slope 10%-90%(Rs1090),etc.]were collected.Based on Ki-67 expression(<50%vs≥50%),patients were divided into low-and high-expression groups.The study evaluated correlations between Ki-67 expression,differentiation degree,and CEUS quantitative parameters to assess tumor aggressiveness.RESULTS Among 54 patients(25 high Ki-67,29 low Ki-67),significant differences(P<0.05)were observed in Rs50,IMAX,wash-out area under the curve(WoutAUC),wash-in and out area under curve,and Rs1090 between high and low Ki-67 groups.High-expression patients showed elevated Rs50,IMAX,WoutAUC,and area under the curve(AUC),while RT and falling slope 50%(Fs50)were lower.Rs1090 demonstrated the highest diagnostic accuracy(AUC=0.863,sensitivity=0.92,specificity=0.759).Fs50 was effective in low Ki-67 detection(AUC=0.838).No correlation was found between enhancement patterns and Ki-67 or differentiation.CONCLUSION CEUS parameters(Rs50,IMAX,WoutAUC,Rs1090)strongly correlate with Ki-67,aiding non-invasive pancreatic cancer assessment.Rs1090/IMAX predict high Ki-67;Fs50 identifies low Ki-67,supporting CEUS for tumor aggressiveness evaluation.展开更多
BACKGROUND Colorectal cancer stands among the most prevalent digestive system malignancies.The microsatellite instability(MSI)profile plays a crucial role in determining patient outcomes and therapy responsiveness.Tra...BACKGROUND Colorectal cancer stands among the most prevalent digestive system malignancies.The microsatellite instability(MSI)profile plays a crucial role in determining patient outcomes and therapy responsiveness.Traditional MSI evaluation methods require invasive tissue sampling,are lengthy,and can be compromised by intratumoral heterogeneity.AIM To establish a non-invasive technique utilizing dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)radiomics and machine learning algorithms to determine MSI status in patients with intermediate-stage rectal cancer.METHODS This retrospective analysis examined 120 individuals diagnosed with stage II/III rectal cancer[30 MSI-high(MSI-H)and 90 microsatellite stability(MSS)/MSI-low(MSI-L)cases].We extracted comprehensive radiomics signatures from DCE-MRI scans,encompassing textural parameters that reflect tumor heterogeneity,shapebased metrics,and histogram-derived statistical values.Least absolute shrinkage and selection operator regression facilitated feature selection,while predictive frameworks were developed using various classification algorithms(logistic regression,support vector machine,and random forest).Performance assessment utilized separate training and validation cohorts.RESULTS Our investigation uncovered distinctive imaging characteristics between MSI-H and MSS/MSI-L neoplasms.MSIH tumors exhibited significantly elevated entropy values(7.84±0.92 vs 6.39±0.83,P=0.004),enhanced surface-tovolume proportions(0.72±0.14 vs 0.58±0.11,P=0.008),and heightened signal intensity variation(3642±782 vs 2815±645,P=0.007).The random forest model demonstrated superior classification capability with area under the curves(AUCs)of 0.891 and 0.896 across training and validation datasets,respectively.An integrated approach combining radiomics with clinical parameters further enhanced performance metrics(AUC 0.923 and 0.914),achieving 88.5%sensitivity alongside 87.2%specificity.CONCLUSION DCE-MRI radiomics features interpreted through machine learning frameworks offer an effective strategy for MSI status assessment in intermediate-stage rectal cancer.展开更多
BACKGROUND Rectal cancer requires accurate preoperative assessment of T stage and differentiation grade for treatment planning.Traditional imaging and serum markers have limitations in diagnostic accuracy.AIM To evalu...BACKGROUND Rectal cancer requires accurate preoperative assessment of T stage and differentiation grade for treatment planning.Traditional imaging and serum markers have limitations in diagnostic accuracy.AIM To evaluate the predictive value of dynamic contrast-enhanced-magnetic resonance imaging(DCE-MRI)parameters and serum biomarkers[carbohydrate antigen(CA)19-9,CA125]for determining T stage and differentiation grade in rectal cancer.METHODS We conducted a retrospective review of clinical data from 126 patients who were pathologically diagnosed with rectal cancer between January 2021 to June 2024.Each patient underwent DCE-MRI scans and serum tests for CA19-9 and CA125.Receiver operating characteristic curves were utilized to assess the diagnostic value of DCE-MRI parameters,including volume transfer constant(Ktrans),rate constant(Kep),and volume fraction of extravascular extracellular space(Ve),as well as serum biomarkers for staging and grading rectal cancer.The DeLong test algorithm was employed to evaluate differences in diagnostic performance among the various indicators.RESULTS There were statistically higher levels of Ktrans,Ve,CA19-9,and CA125 serum concentrations of patients with advanced T stages and on poorly differentiated tumors than that in patients with low stages and moderate to high differentiation(P<0.05).Combined use of Ktrans and Ve for T stage diagnosis showed an area under the curve(AUC)of 0.892[95%confidence interval(CI):0.832-0.952],which increased to 0.923(95%CI:0.865-0.981)when combined with serum biomarkers.For grades differentiation,the combined DCE-MRI parameters had an AUC of 0.883(95%CI:0.821-0.945),which rose to 0.912(95%CI:0.855-0.969)when combined with serum markers.According to the Delong test,the combined diagnostic method performed better than a single diagnostic method(P<0.05).CONCLUSION The combined application of DCE-MRI functional parameters and serum tumor markers can significantly improve the diagnostic accuracy of T staging and differentiation degree of rectal cancer,providing a new approach to improve the preoperative assessment system of rectal cancer.This combined diagnostic model has important clinical application value,but further validation is needed through large-scale multicenter studies.展开更多
AIM To assess the utility of NLR,PLR,IMT and contrast-enhanced ultrasound(CEUS)aspredictive markers for monitoring inflammatory responses and the disease activity in cardiac involvementin Takayasu’s arteritis.METHODS...AIM To assess the utility of NLR,PLR,IMT and contrast-enhanced ultrasound(CEUS)aspredictive markers for monitoring inflammatory responses and the disease activity in cardiac involvementin Takayasu’s arteritis.METHODS A cohort retrospective study encompassing 86 patients(43 withcardiac compromise and 43 without)was conducted.A comparative analysis of NLR,PLR,IMT,andCEUS between TA patients with and without cardiac compromise was undertaken.RESULTS The NLR and PLR of the heart damage group were significantly higher than those of the non heart damagegroup(2.9±1.0 vs.2.1±0.8,P<0.01;166±79 vs.117±51,P<0.01).The IMT and CEUS of the heartdamage group were significantly higher than those of the TA non heart damage group(2.6±0.6 vs.1.5±0.4,P<0.01;2.6±0.5 vs.1.6±0.6,P<0.01).The NLR level of the heart damage group was positivelycorrelated with CRP(r=0.42,P<0.01),and PLR was positively correlated with CRP and CEUS(r=0.34,P<0.05;r=0.35,P<0.05).The results of multiple logistic regression analysis showed that NLR,IMT,andCEUS were independent risk factors for TA and cardiac damage.The area under the ROC curve for NLRto determine cardiac damage is 0.865,with a cut-off value of 2.265,a sensitivity of 69.8%,and aspecificity of 90.7%.The area under the ROC curve for determining cardiac damage using PLR is 0.812,with a cut-off value of 111.275,a sensitivity of 76.7%,and a specificity of 79.1%.CONCLUSION NLR and PLR,in conjunction with contrast-enhanced ultrasound,can be employed to assessinflammatory response and the disease activity in cardiac involvement in Takayasu’s arteritis.展开更多
BACKGROUND Contrast-enhanced ultrasonography(CEUS)is utilized to assess the therapeutic efficacy of interventional therapy in liver cancer patients,offering insights into tumor blood flow changes,angiogenesis,and tumo...BACKGROUND Contrast-enhanced ultrasonography(CEUS)is utilized to assess the therapeutic efficacy of interventional therapy in liver cancer patients,offering insights into tumor blood flow changes,angiogenesis,and tumor markers.AIM To evaluate the use of CEUS in examining the effectiveness of interventional therapy for liver cancer,we aim to investigate its diagnostic utility for tumor perfusion patterns,microvessel density,perfusion recovery,blood flow enhancement response,and alterations in tumor markers among patients receiving interventional therapy for liver cancer.METHODS The study involved 124 patients who underwent interventional therapy for liver cancer at Guangzhou First People’s Hospital from January 2022 to February 2024.All patients were examined using CEUS before treatment and at 1 month,3 months,and 6 months,and the concentrations of tumor markers were collected and statistically analyzed using Statistical Package for the Social Sciences 25.0.Receiver operating characteristic(ROC)curves were used to evaluate the diagnostic efficacy of CEUS and analyze its sensitivity,specificity,and correlation with clinical indicators.RESULTS Before treatment,tumor blood flow was primarily enhanced.After treatment,enhanced perfusion declined,while uniform and non-uniform perfusion increased,indicating reduced tumor activity.Enhanced perfusion decreased from 68.25%before treatment to 53.75%at 6 months post-treatment(F=6.123,P=0.016),indicating reduced tumor activity.The microvessel density of the tumors decreased significantly after treatment(P<0.05),and the proportion of low microvessel density increased.After treatment,perfusion recovery in the tumor area improved,the proportion of complete and partial responses gradually increased,and the proportion of stable lesions decreased(P<0.05).The levels of alphafetoprotein,carcinoembryonic antigen,and carbohydrate antigen 19-9 decreased by 68.7%,30.4%,and 41.6%,respectively,at 6 months post-treatment(P<0.05).CEUS showed a sensitivity of 85.72%,specificity of 92.31%,and area under the curve of 0.911(95%CI:0.883–0.939)for evaluating treatment response.ROC curve analysis showed that CEUS had high sensitivity and specificity and could effectively evaluate the efficacy of interventional therapy for liver cancer.CONCLUSION CEUS has high diagnostic value in evaluating therapeutic effects in patients with liver cancer following interventional therapy.It can reflect changes in tumor blood flow,angiogenesis,and tumor marker levels,providing an effective basis for real-time monitoring of treatment outcomes.展开更多
A primary benign schwannoma of the liver is extremely rare and is difficult to preoperatively discriminate from a malignant tumor.We compared the imaging and pathological findings,and examined the possibility of preop...A primary benign schwannoma of the liver is extremely rare and is difficult to preoperatively discriminate from a malignant tumor.We compared the imaging and pathological findings,and examined the possibility of preoperatively diagnosing a benign liver schwannoma.A 72-year-old woman was admitted to our hospital because of a 4.6-cm mass in the liver.A malignant tumor was suspected,and a right hepatectomy was performed.After this,the diagnosis of a primary benign schwannoma of the liver was made through pathological examination.Contrast-enhanced ultrasonography(CEUS) with Sonazoid showed minute blood flows into the septum and solid areas of the tumor in the vascular phase;most likely due to increased arterial flow associated with infiltration of chronic inflammatory cells.In the postvascular phase,CEUS showed contrast defect of cystic areas and delayed enhancement of solid areas;most likely due to aggregation of siderophores.Because discriminating between a benign and malignant schwannoma of the liver is difficult,surgery is generally recommended.However,the two key findings from CEUS may be useful in discriminating ancient schwannoma by recognizing the hemorrhage involved in the secondary degeneration and aggregation of siderophores.展开更多
AIM: To investigate the relationship between contrastenhanced ultrasound(CEUS),basic fibroblast growth factor(b FGF),endothelin-1(ET-1),and hepatocellular carcinoma(HCC) recurrence after ablation. METHODS: A total of ...AIM: To investigate the relationship between contrastenhanced ultrasound(CEUS),basic fibroblast growth factor(b FGF),endothelin-1(ET-1),and hepatocellular carcinoma(HCC) recurrence after ablation. METHODS: A total of 51 HCC patients(38 males and 13 females) who received radiofrequency ablation in our hospital from June 2012 to July 2014 were enrolled in this study. The patients were divided into two groups: recurrence group and non-recurrence group. Routine abdominal examination was first performed in the horizontal position. Then the patients underwent CEUS and immunohistochemical staining before receiving radiofrequency ablation. All patients were followed-up every three months for one year.The results of CEUS and serum tumor marker levels were evaluated and combined together to estimate HCC recurrence and metastasis. Patients were divided into two groups: recurrence group and non-recurrence group. Quantitative parameters of CEUS and tumor expression levels of b FGF and ET-1 were compared between the two groups,respectively. Binary logistic regression analysis was used to analyze the relationship between CEUS quantitative parameters,expression levels of ET-1 and b FGF,and HCC recurrence after ablation. RESULTS: Based on the quantitative parameters of CEUS before patients received radiofrequency ablation,the levels of tumor rise time(t RT),tumor time to peak(t TTP),tumor peak intensity(t PI) and tumorparenchymal peak intensity(t-p PI) in the recurrence group were significantly lower than those in the nonrecurrence group(16.6 ± 6.1 vs 23.2 ± 7.0,P = 0.000; 41.2 ± 10.2 vs 59.6 ± 14.2,P = 0.000; 23.8 ± 6.7 vs 31.4 ± 6.4,P = 0.000; 7.1 ± 3.4 vs 14.6 ± 7.4,P = 0.000; respectively). The expression levels of b FGF in the recurrence group were significantly higher than those in the non-recurrence group(P < 0.05). Levels of t TTP showed a significant inverse correlation with the level of b FGF in tumors(r =-0.312,P = 0.037). The Binary logistic regression analysis results revealed that the levels of t RT,t TTP,t PI and the level of b FGF were associated with HCC recurrence after radiofrequency ablation(P < 0.05). CONCLUSION: CEUS is a noninvasive and effective method for evaluating the angiogenesis of HCC,and predicting its recurrence and prognosis.展开更多
Ultrasonography(US) and the new applications US elastography(USE) and contrast-enhanced US(CEUS) are used in the screening of thyroid nodules,for which fine-needle aspiration biopsy(FNAB) is the best single diagnostic...Ultrasonography(US) and the new applications US elastography(USE) and contrast-enhanced US(CEUS) are used in the screening of thyroid nodules,for which fine-needle aspiration biopsy(FNAB) is the best single diagnostic test.The aim of the study was to compare the sensitivity,specificity,positive predictive value(PPV),and accuracy of the four examinations in nodules with cytological and histological diagnoses.The study used data from US,FNAB,USE(elasticity(ELX 2/1) index),and CEUS(Peak index and time to peak(TTP) index) evaluated in 73 thyroid nodules in 63 consecutive patients likely to undergo surgery.Cytological-histological correlation was available for 38 nodules.No correlation emerged between nodule size and cytological results.A significant(P=0.03) positive correlation between cumulative US findings and cytological results was found.In addition,significant correlations between cumulative US findings and cytology(P=0.02) and between cumulative US findings and histology(P<0.0001) were found.US showed the best specificity and PPV,and FNAB the best sensitivity.There was no significant difference in the ELX 2/1 index,Peak index,or TTP index among nodules subdivided according to cytological scores.No significant correlation was found between ELX 2/1 index,Peak index,and TTP index,on the one hand,and nodule size,US cumulative findings,cytology,and histology on the other hand.The sensitivity of the ELX 2/1 index was high,but its specificity was very low.The accuracy and PPV of USE were lower than those of the other procedures.Only the correlation between Peak index and cumulative US findings reached a value close to significance.Our ultimate aim is to minimise unnecessary thyroidectomy.US and FNAB continue to play a central diagnostic role.The use of a US score showed high specificity and PPV.The specificity of FNAB was low in this selected series because of the numbers of indeterminate cytological responses.USE and CEUS are innovative techniques that need to be standardized.The ELX 2/1 index,Peak index,and TTP index seem to be unrelated to histology.The best statistical data on USE and CEUS concerned their sensitivity and PPV,respectively.At present,USE and CEUS are too time-consuming and of limited utility in selecting patients for surgery.展开更多
AIM: To prospectively evaluate the usefulness of a pattern-based classification of contrast-enhanced sonographic findings for differential diagnosis of hepatic tumors. METHODS: We evaluated the enhancement pattern of ...AIM: To prospectively evaluate the usefulness of a pattern-based classification of contrast-enhanced sonographic findings for differential diagnosis of hepatic tumors. METHODS: We evaluated the enhancement pattern of the contrast-enhanced sonography images in 586 patients with 586 hepatic lesions, consisting of 383 hepatocellular carcinomas, 89 metastases, and 114 hemangiomas. After injecting a galactose-palmitic acid contrast agent, lesions were scanned by contrast- enhanced harmonic gray-scale sonography in three phases: arterial, portal, and late. The enhancement patterns of the initial 303 lesions were classified retrospectively, and multiple logistic regression analysis was used to identify enhancement patterns that allowed differentiation between hepatic tumors. We then used the pattern-based classification of enhancement we had retrospectively devised to prospectively diagnose 283 liver tumors. RESULTS: Seven enhancement patterns were found to be significant predictors of different hepatic tumors. The presence of homogeneous or heterogeneous enhancement both in the arterial and portal phase was the typical enhancement pattern for hepatocellular carcinoma, while the presence of peritumoral vessels in the arterial phase and ring enhancement or a perfusion defect in the portal phase was the typical enhancement pattern for metastases, and the presence of peripheral nodular enhancement both in the arterial and portal phase was the typical enhancement pattern forhemangioma. The sensitivity, specificity, and accuracy of prospective diagnosis based on the combinations of enhancement patterns, respectively, were 93.2%, 96.2%, and 94.0% for hepatocellular carcinoma, 87.9%, 99.6%, and 98.2% for metastasis, and 95.6%, 94.1%, and 94.3% for hemangioma. CONCLUSION: The pattern-based classification of the contrast-enhanced sonographic findings is useful for differentiating among hepatic tumors.展开更多
Liver transplantation is an effective treatment for patients with end-stage liver disease. Accurate imaging evaluation of the transplanted patient is critical for ensuring that the limited donor liver is functioning a...Liver transplantation is an effective treatment for patients with end-stage liver disease. Accurate imaging evaluation of the transplanted patient is critical for ensuring that the limited donor liver is functioning appropriately. Ultrasound contrast agents(UCAs), in combination with contrastspecific imaging techniques, are increasingly accepted in clinical use for the assessment of the hepatic vasculature, bile ducts and liver parenchyma in pre-, intra- and posttransplant patients. We describe UCAs, their technical requirements, the recommended clinical indications, image interpretation and the limitations for contrastenhanced ultrasound applications in liver transplantation.展开更多
文摘Objective: To evaluate the efficacy, feasibility and safety of contrast-enhanced CT-guided core biopsy of retroperitoneal masses. Materials and Methods: Contrast-enhanced CT-guided biopsy of retroperitoneal masses was performed in 26 patients. Histopathological diagnosis was obtained and accuracy was calculated. Two blinded radiologists determined feasibility of biopsy procedures on routine CT-guidance, and compared accessibility of target lesions using contrast-enhanced and non-contrast-enhanced CT. Results: Satisfactory samples were obtained in all 26 patients and pathological diagnosis was made in 24. Accuracy was 95.5%. Routine CT-guided biopsy punctures were not satisfaction in 4/26 patients, and contrast-enhanced CT scans rendered the target lesions more accessible in 16 patients. Conclusion: Contrast-enhanced CT-guided biopsy increases the feasibility of biopsy of retroperitoneal masses.
文摘Objective: To discuss the correlation of contrast-enhanced CT quantitative parameters with proliferation and invasion gene expression in pancreatic cancer. Methods: A total of 100 patients with pancreatic cancer who were treated in the hospital between May 2015 and May 2017 were selected as pancreatic cancer group, and 48 patients with necrotic pancreatitis who received surgical treatment in the hospital during the same period were selected as pancreatitis group. Differences in pancreatic contrast-enhanced CT value as well as the expression of proliferation-related genes and invasion-related genes in lesion tissue were compared between the two groups, and Pearson test was used to evaluate the correlation of pancreatic cancer tissue CT value with proliferation and invasion gene expression. Results: Contrast-enhanced CT value of pancreatic cancer tissue was lower than that of pancreatitis tissue;proliferation-related genes Bmi-1, Ezrin and FOXC1 mRNA expression in lesion tissue of pancreatic cancer group were higher than those of pancreatitis group while EphB2 and RGC-32 mRNA expression were lower than those of pancreatitis group;invasion-related genes FHL1, JDP2, Let-7f and TFPI-2 mRNA expression in lesion tissue of pancreatic cancer group were lower than those of pancreatitis group while Twist and HOXB7 mRNA expression were higher than those of pancreatitis group. Pearson test showed that the contrast-enhanced CT value of pancreatic cancer was directly correlated with the proliferation and invasion gene expression in lesion tissue. Conclusion: Contrast-enhanced CT value of pancreatic cancer tissue was lower than that of normal pancreas tissue, and the specific CT value was directly correlated with the tumor proliferation and invasion-related gene expression, and can be used as a simple and reliable method for early diagnosis of disease and judgement of illness severity.
文摘Purpose: The purpose of this study was to retrospectively assess the detectability and enhancement pattern of rectal carcinoid tumors on contrast-enhanced computed tomography colonography (CE-CTC). Methods: The study sample consisted of 12 lesions in nine patients of rectal carcinoid tumors. To evaluate the detectability, two radiologists reviewed axial and 3D images including air enema (AE), virtual endoscopy (VE), and virtual colon dissection (VCD). To determine the contrast enhancement pattern of the tumors, the CT attenuation value of each lesion was measured in three phases. Results: Four of the 12 lesions (33%) were detected on axial images in patients in both the prone and supine positions, the sizes of which were 6 mm or larger. Seven lesions (58%), including the four lesions mentioned above, were detected on 3D images including AE and VE in patients in the prone position, the sizes of which were 5 mm or larger. The ranges of CT attenuation values of the lesions at 40 s, 70 s and 240 s were 112 - 147, 116 - 140 and 82 - 97 HU, respectively. Conclusion: Rectal carcinoid tumors are challenging to detect on CE-CTC. They demonstrated enhancement at the early phase and washout at the delayed phase on CE-CTC.
文摘Objective: to analyze the role of dynamic magnetic resonance enhancement in imaging diagnosis of early hepatocellular carcinoma. Methods: sixty-two patients with hepatocytic lesions who were enrolled in our hospital from June 2019 to June 2020 were selected as the research subjects. All patients were examined by dynamic enhanced CT scan and liver MRI. The diagnostic results of the two different methods were analyzed based on pathological examination, and their diagnostic value was compared. Conclusion: liver MRI examination in patients with HCC has relatively high sensitivity and specificity, and excellent application effect, which can provide accurate basis for early diagnosis and later targeted treatment by doctors, and is worthy of clinical application and vigorous promotion.
文摘Objective Primary liver cancer,predominantly hepatocellular carcinoma(HCC),is a significant global health issue,ranking as the sixth most diagnosed cancer and the third leading cause of cancer-related mortality.Accurate and early diagnosis of HCC is crucial for effective treatment,as HCC and non-HCC malignancies like intrahepatic cholangiocarcinoma(ICC)exhibit different prognoses and treatment responses.Traditional diagnostic methods,including liver biopsy and contrast-enhanced ultrasound(CEUS),face limitations in applicability and objectivity.The primary objective of this study was to develop an advanced,lightweighted classification network capable of distinguishing HCC from other non-HCC malignancies by leveraging the automatic analysis of brightness changes in CEUS images.The ultimate goal was to create a user-friendly and cost-efficient computer-aided diagnostic tool that could assist radiologists in making more accurate and efficient clinical decisions.Methods This retrospective study encompassed a total of 161 patients,comprising 131 diagnosed with HCC and 30 with non-HCC malignancies.To achieve accurate tumor detection,the YOLOX network was employed to identify the region of interest(ROI)on both B-mode ultrasound and CEUS images.A custom-developed algorithm was then utilized to extract brightness change curves from the tumor and adjacent liver parenchyma regions within the CEUS images.These curves provided critical data for the subsequent analysis and classification process.To analyze the extracted brightness change curves and classify the malignancies,we developed and compared several models.These included one-dimensional convolutional neural networks(1D-ResNet,1D-ConvNeXt,and 1D-CNN),as well as traditional machine-learning methods such as support vector machine(SVM),ensemble learning(EL),k-nearest neighbor(KNN),and decision tree(DT).The diagnostic performance of each method in distinguishing HCC from non-HCC malignancies was rigorously evaluated using four key metrics:area under the receiver operating characteristic(AUC),accuracy(ACC),sensitivity(SE),and specificity(SP).Results The evaluation of the machine-learning methods revealed AUC values of 0.70 for SVM,0.56 for ensemble learning,0.63 for KNN,and 0.72 for the decision tree.These results indicated moderate to fair performance in classifying the malignancies based on the brightness change curves.In contrast,the deep learning models demonstrated significantly higher AUCs,with 1D-ResNet achieving an AUC of 0.72,1D-ConvNeXt reaching 0.82,and 1D-CNN obtaining the highest AUC of 0.84.Moreover,under the five-fold cross-validation scheme,the 1D-CNN model outperformed other models in both accuracy and specificity.Specifically,it achieved accuracy improvements of 3.8%to 10.0%and specificity enhancements of 6.6%to 43.3%over competing approaches.The superior performance of the 1D-CNN model highlighted its potential as a powerful tool for accurate classification.Conclusion The 1D-CNN model proved to be the most effective in differentiating HCC from non-HCC malignancies,surpassing both traditional machine-learning methods and other deep learning models.This study successfully developed a user-friendly and cost-efficient computer-aided diagnostic solution that would significantly enhances radiologists’diagnostic capabilities.By improving the accuracy and efficiency of clinical decision-making,this tool has the potential to positively impact patient care and outcomes.Future work may focus on further refining the model and exploring its integration with multimodal ultrasound data to maximize its accuracy and applicability.
基金supported in part by the Natural Science Foundation of Beijing Municipality(grant number 7212139)the Natural Science Foundation of Hainan Province(grant number 821MS0821).
文摘Background and aims:Contrast-enhanced ultrasound(CEUS)is widely used in the diagnosis of complications after liver transplantation.This study compared the diagnostic efficacy of CEUS with that of contrast-enhanced computed tomography(CECT)for focal liver lesions in liver transplant recipients.Methods:We retrospectively reviewed 115 liver transplant recipients who were diagnosed to have focal liver lesions at our hospital between June 2015 and June 2023.All patients were examined by CEUS and CECT and had a definitive pathological diagnosis.Based on the diagnostic outcomes,the sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of these imaging modalities in differentiating between benign and malignant lesions were calculated using a four-table method.Differences in diagnostic efficacy between CEUS and CECT with respect to pathological findings were compared using the chi-squared test and Fisher's exact test.The consistency of diagnosis between these modalities was assessed using the linear weighted kappa test.Results:CEUS identified 79 malignant and 36 benign lesions,while CECT detected 81 malignant and 34 benign lesions.The sensitivity,specificity,positive predictive value,negative predictive value,and overall accuracy of CEUS and CECT in diagnosis of focal lesions in transplanted livers were 95.7%vs 97.2%,97.2%vs 96.1%,97.9%vs 97.5%,97.2%vs 98.6%,and 96.4%vs 97.1%,respectively.Both CEUS and CECT demonstrated comparable diagnostic efficacy(κ¼0.899).CEUS showed strong diagnostic consistency with pathological results(κ¼0.912)and was more effective than CECT in diagnosing focal normal liver tissue and fat infiltration(p<0.05).Both methods were equally effective for diagnosis of focal inflammatory lesions,infarction,and hemangioma.Conclusion:CEUS is as effective as CECT for diagnosis of benign and malignant lesions in transplanted livers but surpasses CECT in differentiating benign lesions,particularly focal normal liver tissue and fat infiltration.
文摘This editorial comments on Yang et al’s article that reported a correlation between dynamic contrast-enhanced ultrasound(CEUS)quantitative parameters and Ki67/tumor differentiation.The validation of CEUS as a diagnostic modality in this study deserves merit.However,it raises interesting points of discussion:(1)Since pancreatic cancer is an overarching term that includes conventional pancreatic ductal adenocarcinoma(PDAC),other subtypes,and neuroendocrine neoplasms(NENs),the inclusion/exclusion criteria require better clarification;(2)Most PDACs are grade 1-2 which contrasts with Yang et al’s study where 46%were grade 3;(3)Ki67 is officially recognized for grading NENs,but not for PDAC;(4)Hotspots are selected for the Ki67 grading of NENs.However,for other tumors(e.g.,breast carcinoma),the average count or hotspots are used;(5)There is no agreement for defining high-grade Ki67 cut-off for non-NENs;reports range from 10%to 50%;and(6)Ki67 reflects cellular proliferation but is not always the most important indicator for biologic aggressiveness.That notwithstanding,since the ratification of Ki67 for prognosis in NENs was based on survival outcomes,the real gold standard should be survival,instead of using Ki67 as a surrogate gold standard.In conclusion,the validation of CEUS parameters for PDAC is a work in progress.CEUS is valuable in assessing PDAC but should be viewed as augmenting other modalities such as computed tomography,magnetic resonance imaging,positron emission tomography and endoscopic ultrasound.
基金Supported by the Shenzhen Third People’s Hospital Research Fund,No.25270G1043The Basic and Applied Basic Research Foundation of Guangdong Province,No.2025A1515011934.
文摘Liver transplantation is the primary therapeutic choice for end-stage liver disease.Currently,biliary complications are among the main factors affecting the survival rate and quality of life of liver transplant recipients.Nevertheless,the clinical manifestations of biliary complications following liver transplantation are often non-specific,making early diagnosis and timely treatment crucial for improving patient outcomes.Ultrasound is the preferred imaging method following liver transplantation.Importantly,contrast-enhanced ultrasound,with the adminis-tration of contrast agents,can improve the resolution of biliary images and enable real-time,dynamic visualization of microcirculation perfusion in the biliary system and surrounding tissues.The present article describes the normal ultra-sonic features of the biliary system following liver transplantation and briefly reviews the progress in the ultrasonic diagnosis of common biliary complications,including anastomotic biliary strictures,non-anastomotic biliary strictures,biliary leakage,biloma,and bile sludge/bile stone.
文摘Background:This study evaluates the efficacy of gabexate mesylate thermosensitive in-situ gel(GMTI) in the treatment of beagle grade Ⅲ pancreatic trauma(PT) with the assistance of contrast-enhanced ultrasound(CEUS) and investigates its mechanism of action.Methods:A grade Ⅲ PT model consisting of 15 beagle dogs with severed main pancreatic ducts was created and treated with cephalic vein injection of gabexate mesylate(GM)(1.54mL/10kg,TID) and peripancreatic injection of GMTI(4.63 mL/10 kg,QD) guided by CEUS within 24h post-surgery.Ascites and serum levels of amylase(AMY),lipase(LPS),C-reactive protein(CRP),interleukin(IL)-6,tumor necrosis factor(TNF)-α,and urinary trypsinogen activating peptide(TAP) were detected by ELISA.Histopathological changes in the canine pancreas were observed by Hematoxylin and Eosin staining.Results:CEUS accurately displayed pancreatic lesions and guided catheterisation.Compared to the control group,the ascites was significantly reduced after treatment(p<0.01).AMY and LPS ascites significantly decreased on post-operative 1st and 2nd day(p<0.01).The levels of AMY,LPS,CRP,IL-6,and TNF-α in serum were decreased(p<0.05 or p <0.01).Urinary TAP was decreased 1 and 2 days after treatment(p<0.05or p<0.01,respectively).In the control group,pancreatic tissue necrosis was evident in the wound area.Normal glandular cell structures and fibrous tissue hyperplasia were observed in the wound area after GMTI treatment.The GMTI group performed better than the GM group in improving pancreatic histology and reducing AMY levels in the early post-operative period.Conclusion:Guided by CEUS,daily peripancreatic injections of GMTI in Beagles effectively inhibit pancreatic enzyme activity and aid in the adjuvant treatment of pancreatic trauma.
基金Supported by the Liaoning Province Science and Technology Plan Joint Program,No.2024JH2/102600310.
文摘BACKGROUND The expression level of Ki-67 and the degree of differentiation in pancreatic cancer determine tumor aggressiveness and patient prognosis,which holds significant implications for clinical decision-making.A major challenge in preoperative pancreatic ductal adenocarcinoma management is predicting tumor malignancy.Contrast-enhanced ultrasound(CEUS),a dynamic imaging technique based on blood pool visualization,can reveal lesion vasculature and provide quantitative perfusion data reflecting angiogenesis.By tracking contrast agent kinetics,CEUS offers non-invasive insights into tumor vascularization,helping assess malig-nancy potential.AIM To investigate the correlation between Ki-67 and pancreatic cancer differentiation using CEUS quantitative parameters and evaluated their diagnostic accuracy.METHODS This retrospective study analyzed pancreatic cancer patients who underwent CEUS and pathological confirmation.Pathological differentiation,clinical data,and quantitative CEUS parameters[maximum intensity(IMAX),rise time(RT),rise slope 50%(Rs50),rise slope 10%-90%(Rs1090),etc.]were collected.Based on Ki-67 expression(<50%vs≥50%),patients were divided into low-and high-expression groups.The study evaluated correlations between Ki-67 expression,differentiation degree,and CEUS quantitative parameters to assess tumor aggressiveness.RESULTS Among 54 patients(25 high Ki-67,29 low Ki-67),significant differences(P<0.05)were observed in Rs50,IMAX,wash-out area under the curve(WoutAUC),wash-in and out area under curve,and Rs1090 between high and low Ki-67 groups.High-expression patients showed elevated Rs50,IMAX,WoutAUC,and area under the curve(AUC),while RT and falling slope 50%(Fs50)were lower.Rs1090 demonstrated the highest diagnostic accuracy(AUC=0.863,sensitivity=0.92,specificity=0.759).Fs50 was effective in low Ki-67 detection(AUC=0.838).No correlation was found between enhancement patterns and Ki-67 or differentiation.CONCLUSION CEUS parameters(Rs50,IMAX,WoutAUC,Rs1090)strongly correlate with Ki-67,aiding non-invasive pancreatic cancer assessment.Rs1090/IMAX predict high Ki-67;Fs50 identifies low Ki-67,supporting CEUS for tumor aggressiveness evaluation.
基金Supported by the Natural Science Foundation of Fujian Province,China,No.2022J011460。
文摘BACKGROUND Colorectal cancer stands among the most prevalent digestive system malignancies.The microsatellite instability(MSI)profile plays a crucial role in determining patient outcomes and therapy responsiveness.Traditional MSI evaluation methods require invasive tissue sampling,are lengthy,and can be compromised by intratumoral heterogeneity.AIM To establish a non-invasive technique utilizing dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)radiomics and machine learning algorithms to determine MSI status in patients with intermediate-stage rectal cancer.METHODS This retrospective analysis examined 120 individuals diagnosed with stage II/III rectal cancer[30 MSI-high(MSI-H)and 90 microsatellite stability(MSS)/MSI-low(MSI-L)cases].We extracted comprehensive radiomics signatures from DCE-MRI scans,encompassing textural parameters that reflect tumor heterogeneity,shapebased metrics,and histogram-derived statistical values.Least absolute shrinkage and selection operator regression facilitated feature selection,while predictive frameworks were developed using various classification algorithms(logistic regression,support vector machine,and random forest).Performance assessment utilized separate training and validation cohorts.RESULTS Our investigation uncovered distinctive imaging characteristics between MSI-H and MSS/MSI-L neoplasms.MSIH tumors exhibited significantly elevated entropy values(7.84±0.92 vs 6.39±0.83,P=0.004),enhanced surface-tovolume proportions(0.72±0.14 vs 0.58±0.11,P=0.008),and heightened signal intensity variation(3642±782 vs 2815±645,P=0.007).The random forest model demonstrated superior classification capability with area under the curves(AUCs)of 0.891 and 0.896 across training and validation datasets,respectively.An integrated approach combining radiomics with clinical parameters further enhanced performance metrics(AUC 0.923 and 0.914),achieving 88.5%sensitivity alongside 87.2%specificity.CONCLUSION DCE-MRI radiomics features interpreted through machine learning frameworks offer an effective strategy for MSI status assessment in intermediate-stage rectal cancer.
文摘BACKGROUND Rectal cancer requires accurate preoperative assessment of T stage and differentiation grade for treatment planning.Traditional imaging and serum markers have limitations in diagnostic accuracy.AIM To evaluate the predictive value of dynamic contrast-enhanced-magnetic resonance imaging(DCE-MRI)parameters and serum biomarkers[carbohydrate antigen(CA)19-9,CA125]for determining T stage and differentiation grade in rectal cancer.METHODS We conducted a retrospective review of clinical data from 126 patients who were pathologically diagnosed with rectal cancer between January 2021 to June 2024.Each patient underwent DCE-MRI scans and serum tests for CA19-9 and CA125.Receiver operating characteristic curves were utilized to assess the diagnostic value of DCE-MRI parameters,including volume transfer constant(Ktrans),rate constant(Kep),and volume fraction of extravascular extracellular space(Ve),as well as serum biomarkers for staging and grading rectal cancer.The DeLong test algorithm was employed to evaluate differences in diagnostic performance among the various indicators.RESULTS There were statistically higher levels of Ktrans,Ve,CA19-9,and CA125 serum concentrations of patients with advanced T stages and on poorly differentiated tumors than that in patients with low stages and moderate to high differentiation(P<0.05).Combined use of Ktrans and Ve for T stage diagnosis showed an area under the curve(AUC)of 0.892[95%confidence interval(CI):0.832-0.952],which increased to 0.923(95%CI:0.865-0.981)when combined with serum biomarkers.For grades differentiation,the combined DCE-MRI parameters had an AUC of 0.883(95%CI:0.821-0.945),which rose to 0.912(95%CI:0.855-0.969)when combined with serum markers.According to the Delong test,the combined diagnostic method performed better than a single diagnostic method(P<0.05).CONCLUSION The combined application of DCE-MRI functional parameters and serum tumor markers can significantly improve the diagnostic accuracy of T staging and differentiation degree of rectal cancer,providing a new approach to improve the preoperative assessment system of rectal cancer.This combined diagnostic model has important clinical application value,but further validation is needed through large-scale multicenter studies.
文摘AIM To assess the utility of NLR,PLR,IMT and contrast-enhanced ultrasound(CEUS)aspredictive markers for monitoring inflammatory responses and the disease activity in cardiac involvementin Takayasu’s arteritis.METHODS A cohort retrospective study encompassing 86 patients(43 withcardiac compromise and 43 without)was conducted.A comparative analysis of NLR,PLR,IMT,andCEUS between TA patients with and without cardiac compromise was undertaken.RESULTS The NLR and PLR of the heart damage group were significantly higher than those of the non heart damagegroup(2.9±1.0 vs.2.1±0.8,P<0.01;166±79 vs.117±51,P<0.01).The IMT and CEUS of the heartdamage group were significantly higher than those of the TA non heart damage group(2.6±0.6 vs.1.5±0.4,P<0.01;2.6±0.5 vs.1.6±0.6,P<0.01).The NLR level of the heart damage group was positivelycorrelated with CRP(r=0.42,P<0.01),and PLR was positively correlated with CRP and CEUS(r=0.34,P<0.05;r=0.35,P<0.05).The results of multiple logistic regression analysis showed that NLR,IMT,andCEUS were independent risk factors for TA and cardiac damage.The area under the ROC curve for NLRto determine cardiac damage is 0.865,with a cut-off value of 2.265,a sensitivity of 69.8%,and aspecificity of 90.7%.The area under the ROC curve for determining cardiac damage using PLR is 0.812,with a cut-off value of 111.275,a sensitivity of 76.7%,and a specificity of 79.1%.CONCLUSION NLR and PLR,in conjunction with contrast-enhanced ultrasound,can be employed to assessinflammatory response and the disease activity in cardiac involvement in Takayasu’s arteritis.
基金Supported by Science and Technology Program of Guangzhou,No.2024A03J1029Science and Technology Program of Chinese Medicine and Integrated Chinese and Western Medicine in Guangzhou,No.20252A010001.
文摘BACKGROUND Contrast-enhanced ultrasonography(CEUS)is utilized to assess the therapeutic efficacy of interventional therapy in liver cancer patients,offering insights into tumor blood flow changes,angiogenesis,and tumor markers.AIM To evaluate the use of CEUS in examining the effectiveness of interventional therapy for liver cancer,we aim to investigate its diagnostic utility for tumor perfusion patterns,microvessel density,perfusion recovery,blood flow enhancement response,and alterations in tumor markers among patients receiving interventional therapy for liver cancer.METHODS The study involved 124 patients who underwent interventional therapy for liver cancer at Guangzhou First People’s Hospital from January 2022 to February 2024.All patients were examined using CEUS before treatment and at 1 month,3 months,and 6 months,and the concentrations of tumor markers were collected and statistically analyzed using Statistical Package for the Social Sciences 25.0.Receiver operating characteristic(ROC)curves were used to evaluate the diagnostic efficacy of CEUS and analyze its sensitivity,specificity,and correlation with clinical indicators.RESULTS Before treatment,tumor blood flow was primarily enhanced.After treatment,enhanced perfusion declined,while uniform and non-uniform perfusion increased,indicating reduced tumor activity.Enhanced perfusion decreased from 68.25%before treatment to 53.75%at 6 months post-treatment(F=6.123,P=0.016),indicating reduced tumor activity.The microvessel density of the tumors decreased significantly after treatment(P<0.05),and the proportion of low microvessel density increased.After treatment,perfusion recovery in the tumor area improved,the proportion of complete and partial responses gradually increased,and the proportion of stable lesions decreased(P<0.05).The levels of alphafetoprotein,carcinoembryonic antigen,and carbohydrate antigen 19-9 decreased by 68.7%,30.4%,and 41.6%,respectively,at 6 months post-treatment(P<0.05).CEUS showed a sensitivity of 85.72%,specificity of 92.31%,and area under the curve of 0.911(95%CI:0.883–0.939)for evaluating treatment response.ROC curve analysis showed that CEUS had high sensitivity and specificity and could effectively evaluate the efficacy of interventional therapy for liver cancer.CONCLUSION CEUS has high diagnostic value in evaluating therapeutic effects in patients with liver cancer following interventional therapy.It can reflect changes in tumor blood flow,angiogenesis,and tumor marker levels,providing an effective basis for real-time monitoring of treatment outcomes.
文摘A primary benign schwannoma of the liver is extremely rare and is difficult to preoperatively discriminate from a malignant tumor.We compared the imaging and pathological findings,and examined the possibility of preoperatively diagnosing a benign liver schwannoma.A 72-year-old woman was admitted to our hospital because of a 4.6-cm mass in the liver.A malignant tumor was suspected,and a right hepatectomy was performed.After this,the diagnosis of a primary benign schwannoma of the liver was made through pathological examination.Contrast-enhanced ultrasonography(CEUS) with Sonazoid showed minute blood flows into the septum and solid areas of the tumor in the vascular phase;most likely due to increased arterial flow associated with infiltration of chronic inflammatory cells.In the postvascular phase,CEUS showed contrast defect of cystic areas and delayed enhancement of solid areas;most likely due to aggregation of siderophores.Because discriminating between a benign and malignant schwannoma of the liver is difficult,surgery is generally recommended.However,the two key findings from CEUS may be useful in discriminating ancient schwannoma by recognizing the hemorrhage involved in the secondary degeneration and aggregation of siderophores.
文摘AIM: To investigate the relationship between contrastenhanced ultrasound(CEUS),basic fibroblast growth factor(b FGF),endothelin-1(ET-1),and hepatocellular carcinoma(HCC) recurrence after ablation. METHODS: A total of 51 HCC patients(38 males and 13 females) who received radiofrequency ablation in our hospital from June 2012 to July 2014 were enrolled in this study. The patients were divided into two groups: recurrence group and non-recurrence group. Routine abdominal examination was first performed in the horizontal position. Then the patients underwent CEUS and immunohistochemical staining before receiving radiofrequency ablation. All patients were followed-up every three months for one year.The results of CEUS and serum tumor marker levels were evaluated and combined together to estimate HCC recurrence and metastasis. Patients were divided into two groups: recurrence group and non-recurrence group. Quantitative parameters of CEUS and tumor expression levels of b FGF and ET-1 were compared between the two groups,respectively. Binary logistic regression analysis was used to analyze the relationship between CEUS quantitative parameters,expression levels of ET-1 and b FGF,and HCC recurrence after ablation. RESULTS: Based on the quantitative parameters of CEUS before patients received radiofrequency ablation,the levels of tumor rise time(t RT),tumor time to peak(t TTP),tumor peak intensity(t PI) and tumorparenchymal peak intensity(t-p PI) in the recurrence group were significantly lower than those in the nonrecurrence group(16.6 ± 6.1 vs 23.2 ± 7.0,P = 0.000; 41.2 ± 10.2 vs 59.6 ± 14.2,P = 0.000; 23.8 ± 6.7 vs 31.4 ± 6.4,P = 0.000; 7.1 ± 3.4 vs 14.6 ± 7.4,P = 0.000; respectively). The expression levels of b FGF in the recurrence group were significantly higher than those in the non-recurrence group(P < 0.05). Levels of t TTP showed a significant inverse correlation with the level of b FGF in tumors(r =-0.312,P = 0.037). The Binary logistic regression analysis results revealed that the levels of t RT,t TTP,t PI and the level of b FGF were associated with HCC recurrence after radiofrequency ablation(P < 0.05). CONCLUSION: CEUS is a noninvasive and effective method for evaluating the angiogenesis of HCC,and predicting its recurrence and prognosis.
文摘Ultrasonography(US) and the new applications US elastography(USE) and contrast-enhanced US(CEUS) are used in the screening of thyroid nodules,for which fine-needle aspiration biopsy(FNAB) is the best single diagnostic test.The aim of the study was to compare the sensitivity,specificity,positive predictive value(PPV),and accuracy of the four examinations in nodules with cytological and histological diagnoses.The study used data from US,FNAB,USE(elasticity(ELX 2/1) index),and CEUS(Peak index and time to peak(TTP) index) evaluated in 73 thyroid nodules in 63 consecutive patients likely to undergo surgery.Cytological-histological correlation was available for 38 nodules.No correlation emerged between nodule size and cytological results.A significant(P=0.03) positive correlation between cumulative US findings and cytological results was found.In addition,significant correlations between cumulative US findings and cytology(P=0.02) and between cumulative US findings and histology(P<0.0001) were found.US showed the best specificity and PPV,and FNAB the best sensitivity.There was no significant difference in the ELX 2/1 index,Peak index,or TTP index among nodules subdivided according to cytological scores.No significant correlation was found between ELX 2/1 index,Peak index,and TTP index,on the one hand,and nodule size,US cumulative findings,cytology,and histology on the other hand.The sensitivity of the ELX 2/1 index was high,but its specificity was very low.The accuracy and PPV of USE were lower than those of the other procedures.Only the correlation between Peak index and cumulative US findings reached a value close to significance.Our ultimate aim is to minimise unnecessary thyroidectomy.US and FNAB continue to play a central diagnostic role.The use of a US score showed high specificity and PPV.The specificity of FNAB was low in this selected series because of the numbers of indeterminate cytological responses.USE and CEUS are innovative techniques that need to be standardized.The ELX 2/1 index,Peak index,and TTP index seem to be unrelated to histology.The best statistical data on USE and CEUS concerned their sensitivity and PPV,respectively.At present,USE and CEUS are too time-consuming and of limited utility in selecting patients for surgery.
文摘AIM: To prospectively evaluate the usefulness of a pattern-based classification of contrast-enhanced sonographic findings for differential diagnosis of hepatic tumors. METHODS: We evaluated the enhancement pattern of the contrast-enhanced sonography images in 586 patients with 586 hepatic lesions, consisting of 383 hepatocellular carcinomas, 89 metastases, and 114 hemangiomas. After injecting a galactose-palmitic acid contrast agent, lesions were scanned by contrast- enhanced harmonic gray-scale sonography in three phases: arterial, portal, and late. The enhancement patterns of the initial 303 lesions were classified retrospectively, and multiple logistic regression analysis was used to identify enhancement patterns that allowed differentiation between hepatic tumors. We then used the pattern-based classification of enhancement we had retrospectively devised to prospectively diagnose 283 liver tumors. RESULTS: Seven enhancement patterns were found to be significant predictors of different hepatic tumors. The presence of homogeneous or heterogeneous enhancement both in the arterial and portal phase was the typical enhancement pattern for hepatocellular carcinoma, while the presence of peritumoral vessels in the arterial phase and ring enhancement or a perfusion defect in the portal phase was the typical enhancement pattern for metastases, and the presence of peripheral nodular enhancement both in the arterial and portal phase was the typical enhancement pattern forhemangioma. The sensitivity, specificity, and accuracy of prospective diagnosis based on the combinations of enhancement patterns, respectively, were 93.2%, 96.2%, and 94.0% for hepatocellular carcinoma, 87.9%, 99.6%, and 98.2% for metastasis, and 95.6%, 94.1%, and 94.3% for hemangioma. CONCLUSION: The pattern-based classification of the contrast-enhanced sonographic findings is useful for differentiating among hepatic tumors.
基金Supported by National Natural Science Foundation of ChinaNo.81371554+1 种基金Science and Technology Planning Project of Guangdong Province of ChinaNo.2013B021800092
文摘Liver transplantation is an effective treatment for patients with end-stage liver disease. Accurate imaging evaluation of the transplanted patient is critical for ensuring that the limited donor liver is functioning appropriately. Ultrasound contrast agents(UCAs), in combination with contrastspecific imaging techniques, are increasingly accepted in clinical use for the assessment of the hepatic vasculature, bile ducts and liver parenchyma in pre-, intra- and posttransplant patients. We describe UCAs, their technical requirements, the recommended clinical indications, image interpretation and the limitations for contrastenhanced ultrasound applications in liver transplantation.
