BACKGROUND The treatment technology of liver cancer is progressing.In addition to traditional surgical resection,combined therapies of immunotherapy based on immune checkpoint inhibitors,chemotherapy,and transcatheter...BACKGROUND The treatment technology of liver cancer is progressing.In addition to traditional surgical resection,combined therapies of immunotherapy based on immune checkpoint inhibitors,chemotherapy,and transcatheter arterial chemoembolization for hepatocellular carcinoma are more and more widely used.Accurate preoperative diagnosis of liver cancer will provide important information for comprehensive treatment and prognosis evaluation of liver cancer.Sonazoidcontrast-enhanced ultrasound is not only helpful for the qualitative diagnosis of liver lesions,but also has great potential in the diagnosis of histological differentiation of liver cancer.AIM To assess the differentiation of hepatocellular carcinoma(HCC)by utilizing the parameters and imaging features of Sonazoid-contrast-enhanced ultrasound(CEUS).METHODS A retrospective analysis was conducted on the CEUS data of 239 lesions through case-control study.These patients received Sonazoid-CEUS within one week before surgery and were confirmed as HCC by postoperative pathology.Within the cases,patients were further categorized into well-differentiated and poorlydifferentiated group.Time-intensity curves of the region of interest in both arterial and Kupffer phases were generated,allowing for the acquisition of quantitative parameters to assess the diagnostic efficacy in distinguishing lesions between these two groups and determining an appropriate cut-off value.RESULTS Univariate analysis showed that the absolute value of enhancement intensity(EIAV),intensity ratio(IR)and intensity difference(ID)in Kupffer phase were statistically different between the groups with different degree(P=0.015,P=0.000,P=0.000).The sensitivity and specificity were 40.2%,82.4%,80.4% and 78.1%,86.9% and 74.5%,respectively,for differentiating HCC lesions with EIAV≥56.384 dB,IR≥1.215 and ID≥9.184 dB.The area under the receiver operating characteristic curve were 0.590,0.877,0.815.There was no significant difference in the parameters of arterial phase,including peak time,initial growth time,rise time and the absolute value of peak intensity of lesions between the two groups(P>0.05).Multivariate analysis showed that the level of alphafetoprotein(AFP)and IR were risk factors for poor differentiation(P=0.001).CONCLUSION Among the parameters of Sonazoid-CEUS,IR in Kupffer phase exhibits superior diagnostic efficacy with high sensitivity and specificity in the diagnose of pathological differentiation of HCC.Combined with preoperative AFP level,a more accurate diagnosis will be obtained.Compared with portal vein phase,Kupffer phase showed the ability to identify HCC lesions more sensitive.These findings hold significant guiding implications and reference value for clinical practice.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 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
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 Contrast-enhanced ultrasound(CEUS)offers valuable reference data for the early diagnosis of hepatocellular carcinoma(HCC)through dynamic enhancement patterns and quantitative analysis.AIM To evaluate the cl...BACKGROUND Contrast-enhanced ultrasound(CEUS)offers valuable reference data for the early diagnosis of hepatocellular carcinoma(HCC)through dynamic enhancement patterns and quantitative analysis.AIM To evaluate the clinical value,diagnostic accuracy,and imaging characteristics of CEUS in the early diagnosis of HCC and its correlation with HCC pathological findings.METHODS This single-center retrospective study included 125 patients suspected of having primary liver cancer who underwent CEUS at the Department of Hepatobiliary Surgery and Imaging of our hospital from January 2022 to March 2024.All patients were diagnosed with HCC via postoperative pathology or puncture histology.All patients underwent conventional ultrasound examination and CEUS,while some underwent computed tomography or magnetic resonance imaging examination.Clinical data,liver function,serological indicators,and imaging results were collected.Key CEUS indicators,including arterial phase enhancement time(APT)and peak enhancement intensity(PEI),were analyzed.RESULTS Of the 125 patients,66.40%were male,with a mean age of 56.74±11.25 years.Conventional type HCC accounted for 71.20%,with histological grades I(14.40%),II(51.20%),and III-IV(34.40%).CEUS enhancement patterns included“fast-in and fast-out”(36%),“fast-in and slow-out”(40%),and“continuous enhancement”(24%).APT<15 seconds was observed in 40%of patients,and PEI≥1.5 in 56%.Correlation analysis revealed significant negative correlations between tumor differentiation grade and APT,washout completion time,and longest diameter(P<0.01).Logistic regression identified PEI[odds ratio(OR)=3.374],WIT(OR=0.541),lesion boundary characteristics,and APT(OR=0.471)as significant predictors.Receiver operating characteristic analysis demonstrated high diagnostic performance:PEI(area under the curve=0.893),WIT(0.851),lesion boundary characteristics(0.876),and APT(0.864),all with Youden’s index>0.4.Subgroup analysis showed comparable overall diagnostic performance between CEUS and computed tomography/magnetic resonance imaging,but computed tomography/magnetic resonance imaging had higher sensitivity and specificity for Liver Imaging Reporting and Data System 5 lesions(P=0.032).CONCLUSION CEUS holds significant clinical value in the early diagnosis of HCC,as it effectively identifies the typical imaging characteristics of early-stage HCC through dynamic contrast enhancement and quantitative analysis,particularly during the arterial and portal phases.As a non-invasive,cost-effective,and efficient imaging modality,CEUS has a broad clinical application potential.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
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
BACKGROUND Omental torsion(OT)is a rare cause of acute abdomen,it can be difficult to diagnose preoperatively and is frequently misdiagnosed.Computed tomography(CT)is the primary imaging modality for OT.It typically s...BACKGROUND Omental torsion(OT)is a rare cause of acute abdomen,it can be difficult to diagnose preoperatively and is frequently misdiagnosed.Computed tomography(CT)is the primary imaging modality for OT.It typically shows the swirl sign.contrast-enhanced CT can better visualize the central vascular structure of the mass,thus improving the diagnostic accuracy for OT.Surgical resection is the mainstay of treatment for OT.Laparoscopy allows direct visualization of the primary torsion site and comprehensive abdominal exploration,thereby decreasing misdiagnoses.It is a safe and reliable approach for OT treatment,which offers the advantages of minimal trauma,mild postoperative pain,and rapid recovery for stylistic precision.CASE SUMMARY A 48-year-old man was admitted to our hospital due to lower right abdominal pain for the preceding 70 hours.Physical examination revealed lower right abdominal muscle strain,tenderness,and rebound pain,but no mass was palpable.Contrast-enhanced CT revealed a thickened,blurred omentum with swirling changes in the right abdomen.Laparoscopic exploration and omentectomy were performed in the emergency setting.The procedure revealed 50 mL of dark-red bloody ascites in the pelvis and twisting of the right omentum along its longitudinal axis,with a 10 cm×8 cm purple-black necrosis at the distal end.Postsurgical pathology revealed omental hemorrhage,degeneration,and necrosis.The patient had an uneventful recovery and was discharged on the fourth postoperative day.During the subsequent nine-month follow-up,he remained asymptomatic.CONCLUSION OT is a rare disease that lacks specific clinical manifestations.Abdominal contrast-enhanced CT plays a crucial role in diagnosing OT,and laparoscopic surgery is a safe and effective diagnostic and therapeutic approach.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 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
Objective:To systematically evaluate global research trends on contrast-enhanced ultrasound(CEUS)in tumor diagnosis using bibliometric methods.Methods:Publications from January 2000 to June 2025 were retrieved from th...Objective:To systematically evaluate global research trends on contrast-enhanced ultrasound(CEUS)in tumor diagnosis using bibliometric methods.Methods:Publications from January 2000 to June 2025 were retrieved from the Web of Science Core Collection(SCI-EXPANDED).Only English-language articles and reviews were included.A total of 3,493 records were analyzed.VOSviewer 1.6.20 were used for bibliometric and visualization analyses,covering annual output,countries and institutions,authors,journals,keyword co-occurrence,collaboration networks,and co-citation patterns.Results:The number of publications demonstrated steady growth with acceleration after 2018,peaking in 2021 and 2023(>350 papers/year).Dietrich Christoph F.was the most productive and influential author,while Chinese scholars(e.g.,Dong Yi,Wang Wen-Ping)and institutions such as Sun Yat-sen University and Fudan University emerged as leading contributors.European journals,particularly Ultrasound in Medicine and Biology and European Radiology,showed high academic influence.Keyword analysis revealed liver cancer,especially hepatocellular carcinoma,as the dominant research theme,with expanding applications in breast,renal,and prostate tumors.Collaboration networks highlighted strong partnerships between China and Europe,whereas North American participation remained limited.Co-citation analysis indicated that a small number of highly cited studies shaped the intellectual foundation of the field.Conclusion:CEUS research in tumor diagnosis has expanded rapidly,characterized by concentrated leadership,thematic diversification,and strengthening international collaboration.With advances in artificial intelligence,super-resolution imaging,and novel contrast agents,CEUS is expected to evolve from a diagnostic tool into an integrated platform for tumor detection,treatment monitoring,and personalized cancer care.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
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 The role of cerebral microvascular dysfunction in early cognitive impairment and dementia has become increasingly recognized.Furthermore,pathological changes in both Alzheimer’s disease and vascular dement...BACKGROUND The role of cerebral microvascular dysfunction in early cognitive impairment and dementia has become increasingly recognized.Furthermore,pathological changes in both Alzheimer’s disease and vascular dementia are almost always associated with cerebral hemodynamic deficits.AIM To investigate the diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)assessment of the blood-brain barrier(BBB)in combination with relevant plasma biomarkers for mild cognitive impairment(MCI).METHODS This study selected 50 patients with non-amnestic MCI(na-MCI group),52 patients with amnestic MCI(a-MCI group),and 55 healthy elderly controls(control group).The Chinese version of the Montreal cognitive assessment(MoCA),auditory verbal learning test(AVLT),Hamilton anxiety/depression scale(HAMA/HAMD),and activity of daily living(ADL)scales were used to analyze the characteristics of mental and behavioral symptoms of patients with MCI.The DCE-MRI technique was used to assess the contrast enhancement kinetics.The Patlak model was utilized to analyze the BBB permeability(volume transfer constants).Further,fasting blood was was used to quantify plasma homocysteine(Hcy),β-amyloid protein(Aβ)40,Aβ42,human phosphorylated tau-181 protein(p-tau181),intercellular adhesion molecule-1(ICAM-1),vascular cell adhesion molecule-1(VCAM-1),and plasminogen activator inhibitor-1(PAI-1)levels,as well as serum neurofilament light chain(NFL)and glial fibrillary acidic protein(GFAP)concentrations.RESULTS The na-MCI and a-MCI groups demonstrated significantly lower MoCA and AVLT-Huashan version scores,and statistically higher HAMA,HAMD,and ADL scores compared to the control group.Moreover,the a-MCI group showed notably higher HAMA,HAMD,and ADL scores compared to the na-MCI group.Cranial MRI results revealed significant disparities in cerebral blood flow in the left and right frontal lobes,temporal lobes,hippocampi,cuneus,precuneus,parietal lobes,basal ganglia,and occipital lobes between the a-MCI and na-MCI groups.Compared to healthy controls,patients with MCI demonstrated a smaller amplitude of hippocampal contrast enhancement kinetics and a slower decay rate,indicating smaller vascular volume and increased BBB permeability.Further,Hcy,p-tau181,ICAM-1,VCAM-1,PAI-1,and NFL levels were substantially higher in the a-MCI group than in the na-MCI group,whereas the Aβ42 level was significantly lower.We did not observe any significant differences in Aβ40 and GFAP levels.CONCLUSION Patients with MCI may have experienced cerebrovascular system changes in the hippocampal region.Disorders associated with changes in cerebral blood supply may begin before pathophysiological changes are visible by imaging,which provides references for the assessment and treatment of patients with cognitive disorders.Further,DCE-MRI provides a noninvasive approach to diagnose subtle BBB leakage associated with cerebrovascular pathology.展开更多
The management of patients with colorectal cancer(CRC)mainly lies on the use of magnetic resonance imaging(MRI)technique as a diagnostic tool for both staging and restaging.AIM To explore the preoperative value of qua...The management of patients with colorectal cancer(CRC)mainly lies on the use of magnetic resonance imaging(MRI)technique as a diagnostic tool for both staging and restaging.AIM To explore the preoperative value of quantitative parameters of dynamic contrastenhanced MRI(DCE-MRI)in evaluating clinical stages of CRC.METHODS A total of 86 CRC patients undergoing DCE-MRI examinations were included and then classified into CRC group(n=46)and benign tumor group(n=40)according to surgical and pathological results.Quantitative parameters of DCE-MRI,including volume transfer constant(Ktrans),rate constant(Kep)and extravascular extracellular volume fraction(Ve),were analyzed between two groups and among CRC at different stages.Receiver operating characteristic(ROC)curves with of quantitative parameters of DCE-MRI for clinical diagnosis and preoperative staging of CRC were plotted.RESULTS The CRC group had 9 cases with tumor in the upper segment,21 cases in the middle segment,16 in the low segment,10 cases with well differentiation,27 cases with moderate differentiation,and 9 cases with poor differentiation.The Ktrans,Kep,and Ve in the CRC group were higher than those in the benign tumor group(P<0.05).The ROC curves indicated that the optimal cutoff values of Ktrans,Kep and Ve for diagnosing CRC were 0.905 minute-1,0.225 minute-1 and 0.585%,respectively.The Ktrans,Kep and Ve as a combined tool to diagnose CRC yielded 0.863 of area under the curve and 82.60%of sensitivity,and both values were higher than those yielded by Ktrans,Kep,or Ve alone(P<0.05).The Ktrans,Kep and Ve in CRC patients at T3-T4 stage or N1-N2 stage were higher than those at T1-T2 stage or N0 stage(P<0.05).Results of Spearman correlation analysis showed that the Ktrans,Kep and Ve were correlated with advanced T and N stages in CRC patients(P<0.05).The ROC results indicated that the Ktrans produced a higher specificity(81.48%)and sensitivity(94.70%)in evaluating preoperative T stage of CRC.The Kep generated a higher specificity(96.00%)and sensitivity(81.00%)in evaluating preoperative N stage of CRC.CONCLUSION The study suggests that the values of Ktrans,Kep and Ve of DCE-MRI exhibit good performance in diagnosing CRC and preoperative assessment of clinical stages.However,relatively small sample size should be considered for data interpretation.展开更多
BACKGROUND Contrast-enhanced ultrasound(CEUS)is considered a secondary examination compared to computed tomography(CT)and magnetic resonance imaging(MRI)in the diagnosis of hepatocellular carcinoma(HCC),due to the ris...BACKGROUND Contrast-enhanced ultrasound(CEUS)is considered a secondary examination compared to computed tomography(CT)and magnetic resonance imaging(MRI)in the diagnosis of hepatocellular carcinoma(HCC),due to the risk of misdiagnosing intrahepatic cholangiocarcinoma(ICC).The introduction of CEUS Liver Imaging Reporting and Data System(CEUS LI-RADS)might overcome this limitation.Even though data from the literature seems promising,its reliability in real-life context has not been well-established yet.AIM To test the accuracy of CEUS LI-RADS for correctly diagnosing HCC and ICC in cirrhosis.METHODS CEUS LI-RADS class was retrospectively assigned to 511 nodules identified in 269 patients suffering from liver cirrhosis.The diagnostic standard for all nodules was either biopsy(102 nodules)or CT/MRI(409 nodules).Common diagnostic accuracy indexes such as sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)were assessed for the following associations:CEUS LR-5 and HCC;CEUS LR-4 and 5 merged class and HCC;CEUS LR-M and ICC;and CEUS LR-3 and malignancy.The frequency of malignant lesions in CEUS LR-3 subgroups with different CEUS patterns was also determined.Inter-rater agreement for CEUS LI-RADS class assignment and for major CEUS pattern identification was evaluated.RESULTS CEUS LR-5 predicted HCC with a 67.6%sensitivity,97.7%specificity,and 99.3%PPV(P<0.001).The merging of LR-4 and 5 offered an improved 93.9%sensitivity in HCC diagnosis with a 94.3%specificity and 98.8%PPV(P<0.001).CEUS LR-M predicted ICC with a 91.3%sensitivity,96.7%specificity,and 99.6%NPV(P<0.001).CEUS LR-3 predominantly included benign lesions(only 28.8%of malignancies).In this class,the hypo-hypo pattern showed a much higher rate of malignant lesions(73.3%)than the iso-iso pattern(2.6%).Inter-rater agreement between internal raters for CEUS-LR class assignment was almost perfect(n=511,k=0.94,P<0.001),while the agreement among raters from separate centres was substantial(n=50,k=0.67,P<0.001).Agreement was stronger for arterial phase hyperenhancement(internal k=0.86,P<2.7×10-214;external k=0.8,P<0.001)than washout(internal k=0.79,P<1.6×10-202;external k=0.71,P<0.001).CONCLUSION CEUS LI-RADS is effective but can be improved by merging LR-4 and 5 to diagnose HCC and by splitting LR-3 into two subgroups to differentiate iso-iso nodules from other patterns.展开更多
AIM： To investigate the value of two-dimensional （2D） and three-dimensional （3D） double contrast-enhanced ultrasonography （DCUS） imaging for evaluation of gas- tric lesions. METHODS： 2D and 3D DCUS imaging wit...AIM： To investigate the value of two-dimensional （2D） and three-dimensional （3D） double contrast-enhanced ultrasonography （DCUS） imaging for evaluation of gas- tric lesions. METHODS： 2D and 3D DCUS imaging with both oral and intravenous administrations of contrast agents was used to assess gastroscopiclly-confirmed gastric lesions in 46 patients with benign and malignant diseases. Initially, liquid-based ultrasound contrast agent （Xinzhang） was given orally at dose of 500-600 mL for conventional ultrasound examination of the gastric lesions, and then a microbubble-based contrast agent （SonoVue） was injected intravenously at dose of 1.2-2.4 mL in bolus fashion to assess the perfusion pattern of the lesions using contrast imaging modes. The parameters derived from time-intensity curves including the arrival time （AT）, time to peak （lq-P）, peak intensity （PI） and en- hanced intensity （EI） were measured on the 2D DCUS imaging. 3D DCUS of the lesions was acquired to dem- onstrate the value of this imaging mode. RESULTS： There were 22 cases with benign lesions including chronic gastritis （n= 5）, gastric ulcer （n = 9）, gastric polyps （n = 3）, gastric stromal tumors （n = 5）, and 24 cases with malignant lesions including gastric cancer （n = 20）, gastric cardia carcinoma （n = 3） and post-operative recurrent gastric cancer （n = 1） in the study, The oral contrast-enhanced ultrasonography （CEUS） imaging of the stomach clearly demonstrated the anatomy of the stomach and morphologic features of gastric lesions, With optimal scanning window and imaging display under oral CEUS, intravenous CEUS clearly showed the perfusion of gastric lesions with various characteristic manifestations. Both 2D and 3D DCUS images clearly demonstrated normal gastric wall as a three-layer structure, from the inside out, hypere- choic mucosa, hypoechoic muscularis and hyperechoic serosa, respectively. There were statistical significant differences of AT （8.68±2.06 vs 10.43 ±2.75, P = 0.017）, PI （34.64 ± 6.63 vs 29.58 ± 8.22, P = 0.023） and EI （29.72 ± 6.69 vs 22.66 ± 7.01, P = 0.001） between malignant lesions and normal gastric wall. However, no differences of AT, PI and EI between benign lesions and normal gastric wall tissue were found. 3D DCUS could intuitively display morphological features and vascularities of the lesions with multiplanar and volume views. 3D DCUS imaging provided comprehen- sive information complementary to 2D imaging. The crater or wellhead appearances and feeding vessels as well as distorted nourishing vasculature of gastric carcinoma were better seen with 3D imaging than 2D imaging. CONCLUSION： DCUS imaging can simultaneouslydisplay the anatomic and perfusion features of gastric lesions. 3D DCUS can provide additional information to 2D DCUS for evaluation of gastric lesions.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
BACKGROUND Cervical lymph node metastasis in papillary thyroid carcinoma(PTC) affects the treatment and prognosis of patients. Ultrasound is a common imaging method for detecting cervical lymph nodes in PTC patients; ...BACKGROUND Cervical lymph node metastasis in papillary thyroid carcinoma(PTC) affects the treatment and prognosis of patients. Ultrasound is a common imaging method for detecting cervical lymph nodes in PTC patients; however, it is not accurate in determining lymph node metastasis.AIM To evaluate the value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in PTC.METHODS A total of 94 patients with PTC were recruited. According to pathological results,lymph nodes were divided into two groups: metastatic group(n = 50) and reactive group(n = 63). The routine ultrasound findings, contrast-enhanced ultrasound and elastography data were recorded and compared. Logistic regression was used to generate predictive probability distributions for the diagnosis of lymph node metastasis with different indicators. Receiver operating characteristic curve analysis was used to test the efficacy of contrast-enhanced ultrasound combined with elastography based on routine ultrasound in evaluating PTC cervical lymph node metastasis.RESULTS The ratio of long diameter/short diameter(L/S) ≤ 2, irregular marginal morphology, missing lymphatic portal, peripheral or mixed blood flow distribution, peak intensity(PI), non-uniform contrast distribution and elasticity score in the metastatic group were significantly higher than those in the reactive group(P < 0.05). L/S ratio, missing lymphatic portal, PI and elasticity score had a significant influence on the occurrence of PTC cervical lymph node metastasis(P< 0.05). Furthermore, the area under the curve(AUC) for lymph node metastasis diagnosed using the combination of PI ratio, elasticity score, missing lymphatic portal and LS was 0.936, which was significantly higher than the AUC for PI ratio alone. The difference was statistically significant(P < 0.05). The fitting equation for the combined diagnosis was logit(P) =-12.341 + 1.482 × L/S ratio + 3.529 ×missing lymphatic portal + 0.392 × PI + 3.288 × elasticity score.CONCLUSION Based on the gray-scale ultrasound, the combination of contrast-enhanced ultrasound and elastography can accurately assess PTC cervical lymph node metastasis.展开更多
AIM： To assess the utility of contrast-enhanced ultrasonography （CEUS） with a second-generation contrast medium in the differential diagnosis between mass-forming pancreatitis and pancreatic carcinoma. METHODS： Fr...AIM： To assess the utility of contrast-enhanced ultrasonography （CEUS） with a second-generation contrast medium in the differential diagnosis between mass-forming pancreatitis and pancreatic carcinoma. METHODS： From our radio-pathology database, we retrieved all the patients affected by mass-forming pancreatitis or pancreatic carcinoma who underwent CEUS. We evaluated the results of CEUS in the study of the 173 pancreatic masses considering the possibilities of a differential diagnosis between mass-forming pancreatitis and pancreatic tumor by identifying the ＂parenchymographic＂ enhancement during the dynamic phase of CEUS, which was considered diagnostic for mass-forming pancreatitis. RESULTS： At CEUS, 94% of the mass-forming pancreatitis showed intralesional parenchymography. CEUS allowed diagnosis of mass-forming pancreatitis with sensitivity of 88.6%, specificity of 97.8%, positive predictive value of 91.2%, negative predictive value of 97.1%, and overall accuracy of 96%. CEUS significantly increased the diagnostic confidence in the differential diagnosis between mass-forming pancreatitis and pancreatic carcinoma, with receiver operating characteristic curve areas from 0.557 （P = 0.1608） for baseline US to 0.956 （P 〈 0.0001） for CEUS. CONCLUSION： CEUS allowed diagnosis of massforming pancreatitis with diagnostic accuracy of 96%. CEUS significantly increases the diagnostic confidence with respect to basal US in discerning mass-forming pancreatitis from pancreatic neoplasm.展开更多
文摘BACKGROUND The treatment technology of liver cancer is progressing.In addition to traditional surgical resection,combined therapies of immunotherapy based on immune checkpoint inhibitors,chemotherapy,and transcatheter arterial chemoembolization for hepatocellular carcinoma are more and more widely used.Accurate preoperative diagnosis of liver cancer will provide important information for comprehensive treatment and prognosis evaluation of liver cancer.Sonazoidcontrast-enhanced ultrasound is not only helpful for the qualitative diagnosis of liver lesions,but also has great potential in the diagnosis of histological differentiation of liver cancer.AIM To assess the differentiation of hepatocellular carcinoma(HCC)by utilizing the parameters and imaging features of Sonazoid-contrast-enhanced ultrasound(CEUS).METHODS A retrospective analysis was conducted on the CEUS data of 239 lesions through case-control study.These patients received Sonazoid-CEUS within one week before surgery and were confirmed as HCC by postoperative pathology.Within the cases,patients were further categorized into well-differentiated and poorlydifferentiated group.Time-intensity curves of the region of interest in both arterial and Kupffer phases were generated,allowing for the acquisition of quantitative parameters to assess the diagnostic efficacy in distinguishing lesions between these two groups and determining an appropriate cut-off value.RESULTS Univariate analysis showed that the absolute value of enhancement intensity(EIAV),intensity ratio(IR)and intensity difference(ID)in Kupffer phase were statistically different between the groups with different degree(P=0.015,P=0.000,P=0.000).The sensitivity and specificity were 40.2%,82.4%,80.4% and 78.1%,86.9% and 74.5%,respectively,for differentiating HCC lesions with EIAV≥56.384 dB,IR≥1.215 and ID≥9.184 dB.The area under the receiver operating characteristic curve were 0.590,0.877,0.815.There was no significant difference in the parameters of arterial phase,including peak time,initial growth time,rise time and the absolute value of peak intensity of lesions between the two groups(P>0.05).Multivariate analysis showed that the level of alphafetoprotein(AFP)and IR were risk factors for poor differentiation(P=0.001).CONCLUSION Among the parameters of Sonazoid-CEUS,IR in Kupffer phase exhibits superior diagnostic efficacy with high sensitivity and specificity in the diagnose of pathological differentiation of HCC.Combined with preoperative AFP level,a more accurate diagnosis will be obtained.Compared with portal vein phase,Kupffer phase showed the ability to identify HCC lesions more sensitive.These findings hold significant guiding implications and reference value for clinical practice.
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.
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 by Science and Technology Program of Chinese Medicine and Integrated Chinese and Western Medicine in Guangzhou,No.20252A010001and Science and Technology Program of Guangzhou,No.2024A03J1029.
文摘BACKGROUND Contrast-enhanced ultrasound(CEUS)offers valuable reference data for the early diagnosis of hepatocellular carcinoma(HCC)through dynamic enhancement patterns and quantitative analysis.AIM To evaluate the clinical value,diagnostic accuracy,and imaging characteristics of CEUS in the early diagnosis of HCC and its correlation with HCC pathological findings.METHODS This single-center retrospective study included 125 patients suspected of having primary liver cancer who underwent CEUS at the Department of Hepatobiliary Surgery and Imaging of our hospital from January 2022 to March 2024.All patients were diagnosed with HCC via postoperative pathology or puncture histology.All patients underwent conventional ultrasound examination and CEUS,while some underwent computed tomography or magnetic resonance imaging examination.Clinical data,liver function,serological indicators,and imaging results were collected.Key CEUS indicators,including arterial phase enhancement time(APT)and peak enhancement intensity(PEI),were analyzed.RESULTS Of the 125 patients,66.40%were male,with a mean age of 56.74±11.25 years.Conventional type HCC accounted for 71.20%,with histological grades I(14.40%),II(51.20%),and III-IV(34.40%).CEUS enhancement patterns included“fast-in and fast-out”(36%),“fast-in and slow-out”(40%),and“continuous enhancement”(24%).APT<15 seconds was observed in 40%of patients,and PEI≥1.5 in 56%.Correlation analysis revealed significant negative correlations between tumor differentiation grade and APT,washout completion time,and longest diameter(P<0.01).Logistic regression identified PEI[odds ratio(OR)=3.374],WIT(OR=0.541),lesion boundary characteristics,and APT(OR=0.471)as significant predictors.Receiver operating characteristic analysis demonstrated high diagnostic performance:PEI(area under the curve=0.893),WIT(0.851),lesion boundary characteristics(0.876),and APT(0.864),all with Youden’s index>0.4.Subgroup analysis showed comparable overall diagnostic performance between CEUS and computed tomography/magnetic resonance imaging,but computed tomography/magnetic resonance imaging had higher sensitivity and specificity for Liver Imaging Reporting and Data System 5 lesions(P=0.032).CONCLUSION CEUS holds significant clinical value in the early diagnosis of HCC,as it effectively identifies the typical imaging characteristics of early-stage HCC through dynamic contrast enhancement and quantitative analysis,particularly during the arterial and portal phases.As a non-invasive,cost-effective,and efficient imaging modality,CEUS has a broad clinical application potential.
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.
文摘BACKGROUND Omental torsion(OT)is a rare cause of acute abdomen,it can be difficult to diagnose preoperatively and is frequently misdiagnosed.Computed tomography(CT)is the primary imaging modality for OT.It typically shows the swirl sign.contrast-enhanced CT can better visualize the central vascular structure of the mass,thus improving the diagnostic accuracy for OT.Surgical resection is the mainstay of treatment for OT.Laparoscopy allows direct visualization of the primary torsion site and comprehensive abdominal exploration,thereby decreasing misdiagnoses.It is a safe and reliable approach for OT treatment,which offers the advantages of minimal trauma,mild postoperative pain,and rapid recovery for stylistic precision.CASE SUMMARY A 48-year-old man was admitted to our hospital due to lower right abdominal pain for the preceding 70 hours.Physical examination revealed lower right abdominal muscle strain,tenderness,and rebound pain,but no mass was palpable.Contrast-enhanced CT revealed a thickened,blurred omentum with swirling changes in the right abdomen.Laparoscopic exploration and omentectomy were performed in the emergency setting.The procedure revealed 50 mL of dark-red bloody ascites in the pelvis and twisting of the right omentum along its longitudinal axis,with a 10 cm×8 cm purple-black necrosis at the distal end.Postsurgical pathology revealed omental hemorrhage,degeneration,and necrosis.The patient had an uneventful recovery and was discharged on the fourth postoperative day.During the subsequent nine-month follow-up,he remained asymptomatic.CONCLUSION OT is a rare disease that lacks specific clinical manifestations.Abdominal contrast-enhanced CT plays a crucial role in diagnosing OT,and laparoscopic surgery is a safe and effective diagnostic and therapeutic approach.
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.
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.
文摘Objective:To systematically evaluate global research trends on contrast-enhanced ultrasound(CEUS)in tumor diagnosis using bibliometric methods.Methods:Publications from January 2000 to June 2025 were retrieved from the Web of Science Core Collection(SCI-EXPANDED).Only English-language articles and reviews were included.A total of 3,493 records were analyzed.VOSviewer 1.6.20 were used for bibliometric and visualization analyses,covering annual output,countries and institutions,authors,journals,keyword co-occurrence,collaboration networks,and co-citation patterns.Results:The number of publications demonstrated steady growth with acceleration after 2018,peaking in 2021 and 2023(>350 papers/year).Dietrich Christoph F.was the most productive and influential author,while Chinese scholars(e.g.,Dong Yi,Wang Wen-Ping)and institutions such as Sun Yat-sen University and Fudan University emerged as leading contributors.European journals,particularly Ultrasound in Medicine and Biology and European Radiology,showed high academic influence.Keyword analysis revealed liver cancer,especially hepatocellular carcinoma,as the dominant research theme,with expanding applications in breast,renal,and prostate tumors.Collaboration networks highlighted strong partnerships between China and Europe,whereas North American participation remained limited.Co-citation analysis indicated that a small number of highly cited studies shaped the intellectual foundation of the field.Conclusion:CEUS research in tumor diagnosis has expanded rapidly,characterized by concentrated leadership,thematic diversification,and strengthening international collaboration.With advances in artificial intelligence,super-resolution imaging,and novel contrast agents,CEUS is expected to evolve from a diagnostic tool into an integrated platform for tumor detection,treatment monitoring,and personalized cancer care.
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.
文摘BACKGROUND The role of cerebral microvascular dysfunction in early cognitive impairment and dementia has become increasingly recognized.Furthermore,pathological changes in both Alzheimer’s disease and vascular dementia are almost always associated with cerebral hemodynamic deficits.AIM To investigate the diagnostic performance of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)assessment of the blood-brain barrier(BBB)in combination with relevant plasma biomarkers for mild cognitive impairment(MCI).METHODS This study selected 50 patients with non-amnestic MCI(na-MCI group),52 patients with amnestic MCI(a-MCI group),and 55 healthy elderly controls(control group).The Chinese version of the Montreal cognitive assessment(MoCA),auditory verbal learning test(AVLT),Hamilton anxiety/depression scale(HAMA/HAMD),and activity of daily living(ADL)scales were used to analyze the characteristics of mental and behavioral symptoms of patients with MCI.The DCE-MRI technique was used to assess the contrast enhancement kinetics.The Patlak model was utilized to analyze the BBB permeability(volume transfer constants).Further,fasting blood was was used to quantify plasma homocysteine(Hcy),β-amyloid protein(Aβ)40,Aβ42,human phosphorylated tau-181 protein(p-tau181),intercellular adhesion molecule-1(ICAM-1),vascular cell adhesion molecule-1(VCAM-1),and plasminogen activator inhibitor-1(PAI-1)levels,as well as serum neurofilament light chain(NFL)and glial fibrillary acidic protein(GFAP)concentrations.RESULTS The na-MCI and a-MCI groups demonstrated significantly lower MoCA and AVLT-Huashan version scores,and statistically higher HAMA,HAMD,and ADL scores compared to the control group.Moreover,the a-MCI group showed notably higher HAMA,HAMD,and ADL scores compared to the na-MCI group.Cranial MRI results revealed significant disparities in cerebral blood flow in the left and right frontal lobes,temporal lobes,hippocampi,cuneus,precuneus,parietal lobes,basal ganglia,and occipital lobes between the a-MCI and na-MCI groups.Compared to healthy controls,patients with MCI demonstrated a smaller amplitude of hippocampal contrast enhancement kinetics and a slower decay rate,indicating smaller vascular volume and increased BBB permeability.Further,Hcy,p-tau181,ICAM-1,VCAM-1,PAI-1,and NFL levels were substantially higher in the a-MCI group than in the na-MCI group,whereas the Aβ42 level was significantly lower.We did not observe any significant differences in Aβ40 and GFAP levels.CONCLUSION Patients with MCI may have experienced cerebrovascular system changes in the hippocampal region.Disorders associated with changes in cerebral blood supply may begin before pathophysiological changes are visible by imaging,which provides references for the assessment and treatment of patients with cognitive disorders.Further,DCE-MRI provides a noninvasive approach to diagnose subtle BBB leakage associated with cerebrovascular pathology.
文摘The management of patients with colorectal cancer(CRC)mainly lies on the use of magnetic resonance imaging(MRI)technique as a diagnostic tool for both staging and restaging.AIM To explore the preoperative value of quantitative parameters of dynamic contrastenhanced MRI(DCE-MRI)in evaluating clinical stages of CRC.METHODS A total of 86 CRC patients undergoing DCE-MRI examinations were included and then classified into CRC group(n=46)and benign tumor group(n=40)according to surgical and pathological results.Quantitative parameters of DCE-MRI,including volume transfer constant(Ktrans),rate constant(Kep)and extravascular extracellular volume fraction(Ve),were analyzed between two groups and among CRC at different stages.Receiver operating characteristic(ROC)curves with of quantitative parameters of DCE-MRI for clinical diagnosis and preoperative staging of CRC were plotted.RESULTS The CRC group had 9 cases with tumor in the upper segment,21 cases in the middle segment,16 in the low segment,10 cases with well differentiation,27 cases with moderate differentiation,and 9 cases with poor differentiation.The Ktrans,Kep,and Ve in the CRC group were higher than those in the benign tumor group(P<0.05).The ROC curves indicated that the optimal cutoff values of Ktrans,Kep and Ve for diagnosing CRC were 0.905 minute-1,0.225 minute-1 and 0.585%,respectively.The Ktrans,Kep and Ve as a combined tool to diagnose CRC yielded 0.863 of area under the curve and 82.60%of sensitivity,and both values were higher than those yielded by Ktrans,Kep,or Ve alone(P<0.05).The Ktrans,Kep and Ve in CRC patients at T3-T4 stage or N1-N2 stage were higher than those at T1-T2 stage or N0 stage(P<0.05).Results of Spearman correlation analysis showed that the Ktrans,Kep and Ve were correlated with advanced T and N stages in CRC patients(P<0.05).The ROC results indicated that the Ktrans produced a higher specificity(81.48%)and sensitivity(94.70%)in evaluating preoperative T stage of CRC.The Kep generated a higher specificity(96.00%)and sensitivity(81.00%)in evaluating preoperative N stage of CRC.CONCLUSION The study suggests that the values of Ktrans,Kep and Ve of DCE-MRI exhibit good performance in diagnosing CRC and preoperative assessment of clinical stages.However,relatively small sample size should be considered for data interpretation.
基金Supported by the Fondazione di Sardegna,No.FDS2019VIDILIthe University of Sassari,No.FAR2019.
文摘BACKGROUND Contrast-enhanced ultrasound(CEUS)is considered a secondary examination compared to computed tomography(CT)and magnetic resonance imaging(MRI)in the diagnosis of hepatocellular carcinoma(HCC),due to the risk of misdiagnosing intrahepatic cholangiocarcinoma(ICC).The introduction of CEUS Liver Imaging Reporting and Data System(CEUS LI-RADS)might overcome this limitation.Even though data from the literature seems promising,its reliability in real-life context has not been well-established yet.AIM To test the accuracy of CEUS LI-RADS for correctly diagnosing HCC and ICC in cirrhosis.METHODS CEUS LI-RADS class was retrospectively assigned to 511 nodules identified in 269 patients suffering from liver cirrhosis.The diagnostic standard for all nodules was either biopsy(102 nodules)or CT/MRI(409 nodules).Common diagnostic accuracy indexes such as sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)were assessed for the following associations:CEUS LR-5 and HCC;CEUS LR-4 and 5 merged class and HCC;CEUS LR-M and ICC;and CEUS LR-3 and malignancy.The frequency of malignant lesions in CEUS LR-3 subgroups with different CEUS patterns was also determined.Inter-rater agreement for CEUS LI-RADS class assignment and for major CEUS pattern identification was evaluated.RESULTS CEUS LR-5 predicted HCC with a 67.6%sensitivity,97.7%specificity,and 99.3%PPV(P<0.001).The merging of LR-4 and 5 offered an improved 93.9%sensitivity in HCC diagnosis with a 94.3%specificity and 98.8%PPV(P<0.001).CEUS LR-M predicted ICC with a 91.3%sensitivity,96.7%specificity,and 99.6%NPV(P<0.001).CEUS LR-3 predominantly included benign lesions(only 28.8%of malignancies).In this class,the hypo-hypo pattern showed a much higher rate of malignant lesions(73.3%)than the iso-iso pattern(2.6%).Inter-rater agreement between internal raters for CEUS-LR class assignment was almost perfect(n=511,k=0.94,P<0.001),while the agreement among raters from separate centres was substantial(n=50,k=0.67,P<0.001).Agreement was stronger for arterial phase hyperenhancement(internal k=0.86,P<2.7×10-214;external k=0.8,P<0.001)than washout(internal k=0.79,P<1.6×10-202;external k=0.71,P<0.001).CONCLUSION CEUS LI-RADS is effective but can be improved by merging LR-4 and 5 to diagnose HCC and by splitting LR-3 into two subgroups to differentiate iso-iso nodules from other patterns.
基金Supported by A key medical project in Nanjing Military District of the Chinese People’s Liberation Army,No. 09Z039
文摘AIM： To investigate the value of two-dimensional （2D） and three-dimensional （3D） double contrast-enhanced ultrasonography （DCUS） imaging for evaluation of gas- tric lesions. METHODS： 2D and 3D DCUS imaging with both oral and intravenous administrations of contrast agents was used to assess gastroscopiclly-confirmed gastric lesions in 46 patients with benign and malignant diseases. Initially, liquid-based ultrasound contrast agent （Xinzhang） was given orally at dose of 500-600 mL for conventional ultrasound examination of the gastric lesions, and then a microbubble-based contrast agent （SonoVue） was injected intravenously at dose of 1.2-2.4 mL in bolus fashion to assess the perfusion pattern of the lesions using contrast imaging modes. The parameters derived from time-intensity curves including the arrival time （AT）, time to peak （lq-P）, peak intensity （PI） and en- hanced intensity （EI） were measured on the 2D DCUS imaging. 3D DCUS of the lesions was acquired to dem- onstrate the value of this imaging mode. RESULTS： There were 22 cases with benign lesions including chronic gastritis （n= 5）, gastric ulcer （n = 9）, gastric polyps （n = 3）, gastric stromal tumors （n = 5）, and 24 cases with malignant lesions including gastric cancer （n = 20）, gastric cardia carcinoma （n = 3） and post-operative recurrent gastric cancer （n = 1） in the study, The oral contrast-enhanced ultrasonography （CEUS） imaging of the stomach clearly demonstrated the anatomy of the stomach and morphologic features of gastric lesions, With optimal scanning window and imaging display under oral CEUS, intravenous CEUS clearly showed the perfusion of gastric lesions with various characteristic manifestations. Both 2D and 3D DCUS images clearly demonstrated normal gastric wall as a three-layer structure, from the inside out, hypere- choic mucosa, hypoechoic muscularis and hyperechoic serosa, respectively. There were statistical significant differences of AT （8.68±2.06 vs 10.43 ±2.75, P = 0.017）, PI （34.64 ± 6.63 vs 29.58 ± 8.22, P = 0.023） and EI （29.72 ± 6.69 vs 22.66 ± 7.01, P = 0.001） between malignant lesions and normal gastric wall. However, no differences of AT, PI and EI between benign lesions and normal gastric wall tissue were found. 3D DCUS could intuitively display morphological features and vascularities of the lesions with multiplanar and volume views. 3D DCUS imaging provided comprehen- sive information complementary to 2D imaging. The crater or wellhead appearances and feeding vessels as well as distorted nourishing vasculature of gastric carcinoma were better seen with 3D imaging than 2D imaging. CONCLUSION： DCUS imaging can simultaneouslydisplay the anatomic and perfusion features of gastric lesions. 3D DCUS can provide additional information to 2D DCUS for evaluation of gastric lesions.
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.
基金Supported by Shenzhen Science and Technology Plan Funding Project,No.201102125
文摘BACKGROUND Cervical lymph node metastasis in papillary thyroid carcinoma(PTC) affects the treatment and prognosis of patients. Ultrasound is a common imaging method for detecting cervical lymph nodes in PTC patients; however, it is not accurate in determining lymph node metastasis.AIM To evaluate the value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in PTC.METHODS A total of 94 patients with PTC were recruited. According to pathological results,lymph nodes were divided into two groups: metastatic group(n = 50) and reactive group(n = 63). The routine ultrasound findings, contrast-enhanced ultrasound and elastography data were recorded and compared. Logistic regression was used to generate predictive probability distributions for the diagnosis of lymph node metastasis with different indicators. Receiver operating characteristic curve analysis was used to test the efficacy of contrast-enhanced ultrasound combined with elastography based on routine ultrasound in evaluating PTC cervical lymph node metastasis.RESULTS The ratio of long diameter/short diameter(L/S) ≤ 2, irregular marginal morphology, missing lymphatic portal, peripheral or mixed blood flow distribution, peak intensity(PI), non-uniform contrast distribution and elasticity score in the metastatic group were significantly higher than those in the reactive group(P < 0.05). L/S ratio, missing lymphatic portal, PI and elasticity score had a significant influence on the occurrence of PTC cervical lymph node metastasis(P< 0.05). Furthermore, the area under the curve(AUC) for lymph node metastasis diagnosed using the combination of PI ratio, elasticity score, missing lymphatic portal and LS was 0.936, which was significantly higher than the AUC for PI ratio alone. The difference was statistically significant(P < 0.05). The fitting equation for the combined diagnosis was logit(P) =-12.341 + 1.482 × L/S ratio + 3.529 ×missing lymphatic portal + 0.392 × PI + 3.288 × elasticity score.CONCLUSION Based on the gray-scale ultrasound, the combination of contrast-enhanced ultrasound and elastography can accurately assess PTC cervical lymph node metastasis.
文摘AIM： To assess the utility of contrast-enhanced ultrasonography （CEUS） with a second-generation contrast medium in the differential diagnosis between mass-forming pancreatitis and pancreatic carcinoma. METHODS： From our radio-pathology database, we retrieved all the patients affected by mass-forming pancreatitis or pancreatic carcinoma who underwent CEUS. We evaluated the results of CEUS in the study of the 173 pancreatic masses considering the possibilities of a differential diagnosis between mass-forming pancreatitis and pancreatic tumor by identifying the ＂parenchymographic＂ enhancement during the dynamic phase of CEUS, which was considered diagnostic for mass-forming pancreatitis. RESULTS： At CEUS, 94% of the mass-forming pancreatitis showed intralesional parenchymography. CEUS allowed diagnosis of mass-forming pancreatitis with sensitivity of 88.6%, specificity of 97.8%, positive predictive value of 91.2%, negative predictive value of 97.1%, and overall accuracy of 96%. CEUS significantly increased the diagnostic confidence in the differential diagnosis between mass-forming pancreatitis and pancreatic carcinoma, with receiver operating characteristic curve areas from 0.557 （P = 0.1608） for baseline US to 0.956 （P 〈 0.0001） for CEUS. CONCLUSION： CEUS allowed diagnosis of massforming pancreatitis with diagnostic accuracy of 96%. CEUS significantly increases the diagnostic confidence with respect to basal US in discerning mass-forming pancreatitis from pancreatic neoplasm.
