Endoscopic ultrasonography(EUS)represents the combination of endoscopy and intraluminal ultrasonography.This allows use of a high-frequency transducer(5-20 MHz)that,due to the short distance to the target lesion,provi...Endoscopic ultrasonography(EUS)represents the combination of endoscopy and intraluminal ultrasonography.This allows use of a high-frequency transducer(5-20 MHz)that,due to the short distance to the target lesion,provides ultrasonographic images of higher resolution than those obtained from other imaging modalities,including multiple-detector-row-computed tomography,magnetic resonance imaging,and positron emission tomography.EUS is now a widely accepted modality for diagnosing pancreatic diseases.However,the most important limitation of EUS has been the lack of specificity in differentiating between benign and malignant changes.In 1992,EUS-guided fine needle aspiration(FNA)of lesions in the pancreas head was introduced into clinical practice,using a curved linear-array echoendoscope.Since then,EUS has evolved from EUS imaging to EUSFNA and wider applications.Interventional EUS for pancreatic cancer includes EUS-FNA,EUS-guided fine needle injection,EUS-guided biliary drainage and anastomosis,EUS-guided celiac neurolysis,radiofrequency ablation,brachytherapy,and delivery of a growing number of anti-tumor agents.This review focuses on interventional EUS,including EUS-FNA and therapeutic EUS for pancreatic cancer.展开更多
Ultrasound has long been an essential tool in nephrology,traditionally used for procedures like vascular access and kidney biopsies.Point-of-care ultrasonography(POCUS),a rapidly evolving bedside technology,is now gai...Ultrasound has long been an essential tool in nephrology,traditionally used for procedures like vascular access and kidney biopsies.Point-of-care ultrasonography(POCUS),a rapidly evolving bedside technology,is now gaining momentum in nephrology by providing real-time imaging to enhance physical examination findings.Unlike comprehensive radiology-performed ultrasound,POCUS focuses on specific clinical questions,providing immediate and actionable insights.This narrative review examines the philosophy behind POCUS,its expanding applications in nephrology,and its impact on patient care,including its role in diagnosing obstructive uropathy,guiding fluid management,and evaluating hemodynamics in cardiorenal syndrome.Additionally,the review addresses barriers to widespread adoption,such as the need for structured training,competency validation,and interdisciplinary cooperation.By integrating POCUS into routine practice,nephrologists can refine diagnostic accuracy,improve patient outcomes,and strengthen the role of bedside medicine.展开更多
BACKGROUND Esophageal bronchogenic cysts(EBCs)are usually discovered incidentally during radiologic or endoscopic examinations.They are rare and prone to misdiagnosis or mistreatment.As a submucosal lesion,the endosco...BACKGROUND Esophageal bronchogenic cysts(EBCs)are usually discovered incidentally during radiologic or endoscopic examinations.They are rare and prone to misdiagnosis or mistreatment.As a submucosal lesion,the endoscopic ultrasonography(EUS)characteristics of EBCs are unclear.AIM To analyze the clinicopathological and EUS characteristics of EBCs.METHODS A total of 22 patients with a histological diagnosis of EBCs who underwent EUS examination were retrospectively included.The clinicopathological and EUS features were collected and analyzed.RESULTS Most of the EBCs were asymptomatic,and no malignant transformation or precancerous changes was found histologically.Most of the EBCs were located in the lower esophagus(72.7%,16/22).A total of 90.9%(20/22)of the EBCs originated from the muscularis propria,and 9.1%(2/22)originated from the submucosa.All of the lesions had clear boundaries.In terms of echo,77.3%(17/22)had a hypoechoic pattern,and 22.7%(5/22)had an anechoic pattern.We found floating echoes inside the lesion,which presented as a punctiform hyperecho in 45.5%(10/22)and a flocculent hypoecho in 36.4%(8/22)of the patients.A total of 45.5%(10/22)displayed posterior wall enhancement.Fourteen patients underwent color doppler,and no blood flow signal was identified.On EUS elastography,the EBCs presented a yellow-green or green pattern(100%,6/6).When contrast-enhanced EUS was used,the EBCs showed no enhancement(100%,5/5).CONCLUSION When a submucosal lesion located at the lower esophagus originates from the intrinsic muscle layer,the possibility of EBCs should be noted,the EUS characteristics of which include a hypoecho with a clear boundary and a posterior wall enhancement,a floating echo inside and no blood flow signal,a yellow-green or green pattern on elastography,and no enhancement on contrast EUS.展开更多
BACKGROUND Magnetic resonance imaging(MRI)and endoscopic ultrasonography(EUS)are recommended in combination for screening pancreatic cancer in high-risk individuals.However,in clinical practice,MRI and EUS are increas...BACKGROUND Magnetic resonance imaging(MRI)and endoscopic ultrasonography(EUS)are recommended in combination for screening pancreatic cancer in high-risk individuals.However,in clinical practice,MRI and EUS are increasingly utilized for pancreatic surveillance during routine health examinations.AIM To investigate the feasibility of these imaging modalities for screening in low-risk individuals.METHODS This retrospective study included patients at low risk for pancreatic cancer who underwent MRI or EUS at two health evaluation centers between March 2019 and December 2024.Basic characteristics,laboratory data,and imaging results were collected.RESULTS A total of 3364 low-risk individuals underwent pancreatic screening:1553(46.1%)received MRI,and 1811 underwent EUS.No significant differences were observed in age or sex distribution between the groups.In imaging screening,EUS demonstrated a higher detection rate of abnormal pancreatic lesions(12.8%vs 2.6%;P<0.001).MRI detected more cystic lesions than did EUS(P<0.001).EUS identified smaller nodular lesions compared to MRI(9.2 mm vs 18.0 mm;P=0.044).The MRI group had a higher number of confirmed intraductal papillary mucinous neoplasms(P=0.031),whereas the EUS group identified more suspected branch-duct intraductal papillary mucinous neoplasms(P<0.001).Pancreatic adenocarcinoma was found in three patients(0.08%),with no significant difference in detection rates between EUS and MRI(0.11%vs 0.06%;P=0.656).CONCLUSION In low-risk individuals,MRI and EUS offer comparable effectiveness for pancreatic cancer surveillance.The choice of imaging strategy for health evaluation depends on cost considerations and degree of invasiveness.展开更多
BACKGROUND Appendicitis is an abdominal medical emergency and can be of various types.It can lead to a series of gastrointestinal symptoms and can affect health status.Therefore,attention should be paid to the diagnos...BACKGROUND Appendicitis is an abdominal medical emergency and can be of various types.It can lead to a series of gastrointestinal symptoms and can affect health status.Therefore,attention should be paid to the diagnosis of appendicitis to improve prognosis.AIM To assess the value of transabdominal superficial ultrasonography(TASU)in the clinical diagnosis of various types of appendicitis.METHODS A total of 100 patients suspected to have acute appendicitis that were admitted to our hospital between July 2022 and July 2024 were selected for this study.All of them underwent conventional abdominal ultrasonography and TASU.Taking surgical pathology as the gold standard,the diagnostic efficacy of the two ultrasonographic examinations was compared,and the ultrasonographic features of patients with different types of appendicitis were analyzed.RESULTS Comparison with the gold standard showed that among the 100 patients suspected of appendicitis,72 cases were diagnosed as appendicitis while 28 cases were deemed to be normal.Compared with conventional abdominal ultrasonography,TASU displayed a higher diagnostic efficiency(P<0.05).Among the 72 patients with acute appendicitis,22 cases were diagnosed as simple appendicitis,26 cases as suppurative appendicitis,and 24 cases as gangrenous appendicitis.TASU was more effective in the diagnosis of the various types of appendicitis,and the difference was significant between groups(P<0.05).Ultrasonography radiographs revealed an enlarged appendix with a tubular anechoic area,a widened lumen,with a visible occlusion or stercoral shadow and a cystic mass in the parenchyma.CONCLUSION TASU can accurately diagnose appendicitis and also be used to identify the various types of appendicitis,thereby having application value.展开更多
BACKGROUND Routine assessment of solid gastric emptying is challenging due to the prolonged test duration and complex meal preparation.Replacing solid test meals with easily prepared,commercially available semisolid m...BACKGROUND Routine assessment of solid gastric emptying is challenging due to the prolonged test duration and complex meal preparation.Replacing solid test meals with easily prepared,commercially available semisolid meals and shortening the test duration can significantly enhance the feasibility and practicality of gastric emptying evaluations.AIM To compare the gastric emptying and antral motility of solid vs semi-solid meals of similar volume and nutritional consistency,and to assess the feasibility of meal substitution and reduction in test duration during the solid gastric emptying assessment.METHODS Thirty healthy volunteers(17 males,age:29.4±6.0 years,body mass index:23.4±2.94 and 13 females,age:37.2±11.9 years,body mass index:22.9±4.34)underwent gastric emptying by real-time ultrasonography after a solid meal and a comparable commercially prepared semi-solid meal(each meal,total calorie 350 kcal,carbohydrates 60%,fat 30%and proteins 10%),on separate dates 1 week apart.The gastric antral area was measured at 5 minutes,15 minutes,30 minutes,45 minutes,60 minutes,90 minutes,120 minutes,150 minutes,180 minutes,210 minutes,and 240 minutes post-ingestion using a previously validated technique and compared between meals.RESULTS Mean and median antral areas,gastric emptying rates,gastric residual ratios,and motility index at each time point were almost similar between meals for up to 3 hours.At the end of 4 hours,the mean emptied percentage of the semisolid meal and solid meal was 81.1%and 70.6%,respectively.The emptying rate of the semisolid meal at 90 minutes significantly correlated with that of 240 minutes.There was no correlation between the solid meal emptying rates at 90 minutes and 240 minutes.CONCLUSION Gastric emptying,residual antral cross-sectional area and antral motility of a semisolid meal are almost similar to that of a solid meal of the same nutritional value until three hours post-ingestion.A semisolid test meal can effectively substitute a solid test meal during ultrasound assessment of gastric emptying,without compromising the validity of the results.Additionally,the ease of preparation and administration of semisolid meals enhances the overall feasibility of gastric emptying assessments.展开更多
BACKGROUND The diagnosis of gastric inflammatory fibroid polyps(IFPs)mainly depends on pathological confirmation after endoscopic or surgical treatment.Gastric IFP have typical manifestations under endoscopic ultrason...BACKGROUND The diagnosis of gastric inflammatory fibroid polyps(IFPs)mainly depends on pathological confirmation after endoscopic or surgical treatment.Gastric IFP have typical manifestations under endoscopic ultrasonography(EUS),but atypical EUS features have also been reported.Previous studies have found that atypical features of gastric IFPs observed under EUS have corresponding histological manifestations.At present,there is no study elaborating the EUS manifestations of gastric IFPs at different pathological stages.We hypothesize that gastric IFPs at different pathological stages may have different EUS features.AIM To describe EUS features of gastric IFPs and compare with their pathological characteristics.METHODS Clinical data of 53 inpatients with pathologically diagnosed gastric IFPs after endoscopic treatment were collected.All patients underwent preoperative EUS.We analyzed the EUS characteristics of the lesions and compared with the pathological characteristics and staging of the resected specimens.RESULTS Most gastric IFPs showed medium-low echo(67.9%),homogeneous echo(90.6%),and unclear boundaries(83%),and involved the second and third layers of the gastric wall(69.8%)under EUS.The echogenicity level and echo homogeneity were significantly correlated with the pathological stage of gastric IFP.Gastric IFPs in the nodular stage presented hypoechoic and homogeneous echo.Gastric IFPs in the fibrovascular stage mostly showed medium-low echo and homogeneous echo.Gastric IFPs in the sclerotic stage showed different echogenicity levels and echo homogeneity.The accuracy of EUS in diagnosing gastric IFPs was 66.0%(35/53),and the accuracy in determining the origin layer of gastric IFPs was 73.4%(39/53).CONCLUSION Gastric IFPs at different pathological stages have different EUS features.In order to improve the diagnostic rate,it is necessary to combine EUS with EUS-guided fine-needle aspiration or artificial intelligence.展开更多
Diaphragmatic function is central to respiration,and its evaluation is critical in intensive care unit(ICU)settings.Ultrasonography is a reliable bedside tool to assess diaphragmatic excursion(DE).[1,2]The conventiona...Diaphragmatic function is central to respiration,and its evaluation is critical in intensive care unit(ICU)settings.Ultrasonography is a reliable bedside tool to assess diaphragmatic excursion(DE).[1,2]The conventional M-mode(MM)offers high-resolution imaging but requires precise alignment,which can be diffi cult in ICU patients.[3-5]Anatomical M-mode(AMM)allows flexible line adjustment,enabling accurate DE measurements despite poor acoustic windows.[6]However,comparative data between MM and AMM are limited.This retrospective study evaluated the concordance between MM and AMM for assessing right DE.展开更多
BACKGROUND Early detection of acute appendicitis(AA)in pediatric cases,critical to avoiding life-threatening complications such as perforation or abscess,remains challenging.AIM To evaluate the utility of abdominal ul...BACKGROUND Early detection of acute appendicitis(AA)in pediatric cases,critical to avoiding life-threatening complications such as perforation or abscess,remains challenging.AIM To evaluate the utility of abdominal ultrasonography(AUS)in diagnosing pediatric AA.METHODS Overall,102 pediatric patients(aged 3-12 years)suspected of having AA were enrolled and divided into the AA(n=78)and non-AA(n=24)groups.All children underwent AUS and computed tomography(CT).Comparative analyses regarding general patient characteristics and appendix-specific parameters were conducted.The diagnostic performance of AUS and CT in pediatric AA was evaluated.RESULTS All appendix-related parameters were greater in the AA group than in the non-AA group.The areas under the receiver-operating characteristic curves for pediatric AA diagnosis using AUS,CT,and AUS+CT were 0.870,0.824,and 0.931(all P<0.001),respectively(AUS:94.87%sensitivity,79.17%specificity;CT:89.74%sensitivity,75.00%specificity;combined:98.72%sensitivity,87.50%specificity).The positive predictive value(PPV),negative predictive value(NPV),accuracy rate,positive detection rate,and misdiagnosis rate of AUS were 93.67%,82.61%,91.18%,72.55%,and 20.83%,respectively.CT had a slightly lower PPV(92.11%)and NPV(69.23%),along with accuracy,positive detection,and misdiagnosis rates of 86.27%,68.63%,and 25%,respectively.Their combination improved performance,yielding 96.25%PPV,95.45%NPV,96.08%accuracy,75.49%positive detection rate,and 12.50%misdiagnosis rate.CONCLUSION AUS demonstrates certain diagnostic potential in AA diagnosis in pediatric patients,and its combination with CT further improves diagnostic efficacy.展开更多
An abrupt decline in respiratory function often presents in patients unable to undergo imaging procedures,especially in critical care settings.Consequently,evaluation using transthoracic lung ultrasonography has been ...An abrupt decline in respiratory function often presents in patients unable to undergo imaging procedures,especially in critical care settings.Consequently,evaluation using transthoracic lung ultrasonography has been developed to promptly diagnose the patient's respiratory conditions at bedside,gaining increasing attention for its utility.However,conventional transthoracic ultrasonography may face challenges in directly accessing the thorax.展开更多
Both endoscopic ultrasonography(EUS)-guided choledochoduodenostomy( EUS- CDS) and EUS-guided hepaticogastrostomy(EUS-HGS) are relatively well established as alternatives to percutaneous transhepatic biliary drainage(P...Both endoscopic ultrasonography(EUS)-guided choledochoduodenostomy( EUS- CDS) and EUS-guided hepaticogastrostomy(EUS-HGS) are relatively well established as alternatives to percutaneous transhepatic biliary drainage(PTBD). Both EUSCDS and EUS-HGS have high technical and clinical success rates(more than 90%) in high-volume centers. Complications for both procedures remain high at 10%-30%. Procedures performed by endoscopists who have done fewer than 20 cases sometimes result in severe or fatal complications. When learning EUSguided biliary drainage(EUS-BD), we recommend a mentor's supervision during at least the first 20 cases. For inoperable malignant lower biliary obstruction, a skillful endoscopist should perform EUS-BD before EUS-guided rendezvous technique(EUS-RV) and PTBD. We should be select EUS-BD for patients having altered anatomy from malignant tumors before balloon-enteroscope-assisted endoscopic retrograde cholangiopancreatography, EUS-RV, and PTBD. If both EUS-CDS and EUS-HGS are available, we should select EUS-CDS, according to published data. EUSBD will potentially become a first-line biliary drainage procedure in the near future.展开更多
Ultrasonography(US) and the new applications US elastography(USE) and contrast-enhanced US(CEUS) are used in the screening of thyroid nodules,for which fine-needle aspiration biopsy(FNAB) is the best single diagnostic...Ultrasonography(US) and the new applications US elastography(USE) and contrast-enhanced US(CEUS) are used in the screening of thyroid nodules,for which fine-needle aspiration biopsy(FNAB) is the best single diagnostic test.The aim of the study was to compare the sensitivity,specificity,positive predictive value(PPV),and accuracy of the four examinations in nodules with cytological and histological diagnoses.The study used data from US,FNAB,USE(elasticity(ELX 2/1) index),and CEUS(Peak index and time to peak(TTP) index) evaluated in 73 thyroid nodules in 63 consecutive patients likely to undergo surgery.Cytological-histological correlation was available for 38 nodules.No correlation emerged between nodule size and cytological results.A significant(P=0.03) positive correlation between cumulative US findings and cytological results was found.In addition,significant correlations between cumulative US findings and cytology(P=0.02) and between cumulative US findings and histology(P<0.0001) were found.US showed the best specificity and PPV,and FNAB the best sensitivity.There was no significant difference in the ELX 2/1 index,Peak index,or TTP index among nodules subdivided according to cytological scores.No significant correlation was found between ELX 2/1 index,Peak index,and TTP index,on the one hand,and nodule size,US cumulative findings,cytology,and histology on the other hand.The sensitivity of the ELX 2/1 index was high,but its specificity was very low.The accuracy and PPV of USE were lower than those of the other procedures.Only the correlation between Peak index and cumulative US findings reached a value close to significance.Our ultimate aim is to minimise unnecessary thyroidectomy.US and FNAB continue to play a central diagnostic role.The use of a US score showed high specificity and PPV.The specificity of FNAB was low in this selected series because of the numbers of indeterminate cytological responses.USE and CEUS are innovative techniques that need to be standardized.The ELX 2/1 index,Peak index,and TTP index seem to be unrelated to histology.The best statistical data on USE and CEUS concerned their sensitivity and PPV,respectively.At present,USE and CEUS are too time-consuming and of limited utility in selecting patients for surgery.展开更多
AIM:To evaluate the detection and differentiation ability of contrast-enhanced intraoperative ultrasonography(CE-IOUS) in hepatocellular carcinoma(HCC) operations.METHODS:Clinical data of 50 HCC patients were retrospe...AIM:To evaluate the detection and differentiation ability of contrast-enhanced intraoperative ultrasonography(CE-IOUS) in hepatocellular carcinoma(HCC) operations.METHODS:Clinical data of 50 HCC patients were retrospective analyzed.The sensitivity,specificity,false negative and false positive rates of contrast enhanced magnetic resonance imaging(CE-MRI),IOUS and CEIOUS were calculated and compared.Surgical strategy changes due to CE-IOUS were analyzed.RESULTS:Lesions detected by CE-MRI,IOUS and CEIOUS were 60,97 and 85 respectively.The sensitivity,specificity,false negative rate,false positive rate of CEMRI were 98.2%,98.6%,98.6%,60.0%,respectively;for IOUS were 50.0%,90.9%,1.8%,1.4%,respectively;and for CE-IOUS were 1.4%,40.0%,50.0%,9.1%,respectively.The operation strategy of 9(9/50,18.0%) cases was changed according to the results of CE-IOUS.CONCLUSION:Compared with CE-MRI,CE-IOUS performs better in detection and differentiation of small metastasis and regenerative nodules.It plays an important role in the decision-making of HCC operation.展开更多
Endoscopic ultrasonography(EUS) is a technique with an established role in the diagnosis and staging of gastro-intestinal tumors. In recent years, the spread of new devices dedicated to tissue sampling has improved th...Endoscopic ultrasonography(EUS) is a technique with an established role in the diagnosis and staging of gastro-intestinal tumors. In recent years, the spread of new devices dedicated to tissue sampling has improved the diagnostic accuracy of EUS fine-needle aspiration. The development of EUS-guided drainage of the biliopancreatic region and abdominal fluid collections has allowed EUS to evolve into an interventional tool that can replace more invasive procedures. Emerging techniques applying EUS in pancreatic cancer treatment and in celiac neurolysis have been described. Recently, confocal laser endomicroscopy has been applied to EUS as a promising technique for the in vivo histological diagnosis of gastro-intestinal, bilio-pancreatic and lymph node lesions. In this state-of-the-art review, we report the most recent data from the literature regarding EUS devices, interventional EUS, EUS-guided confocal laser endomicroscopy and EUS pancreatic cancer treatment, and we also provide an overview of their principles, clinical applications and limitations.展开更多
Contrast agents are increasingly being used to characterize the vasculature in an organ of interest,to better delineate benign from malignant pathology and to aid in staging and directing therapeutic procedures.We rev...Contrast agents are increasingly being used to characterize the vasculature in an organ of interest,to better delineate benign from malignant pathology and to aid in staging and directing therapeutic procedures.We review the mechanisms of action of first,second and third generation contrast agents and their use in various endoscopic procedures in the gastrointestinal tract.Various applications of contrast-enhanced endoscopic ultrasonography include differentiating benign from malignant mediastinal lymphadenopathy,assessment of depth of invasion of esophageal,gastric and gall bladder cancers and visualization of the portal venous system and esophageal varices.In addition,contrast agents can be used to differentiate pancreatic lesions.The use of color Doppler further increases the ability to diagnose and differentiate various pancreatic malignancies.The sensitivity of power Doppler sonography to depict tumor neovascularization can be increased by contrast agents.Contrast-enhanced harmonic imaging is a useful aid in identifying the tumor vasculature and studying pancreatic microperfusion.In the future,these techniques could potentially be used to quantify tumor perfusion,to assess and monitor the efficacy of antiangiogenic agents,to assist targeted drug delivery and allow molecular imaging.展开更多
AIM: To estimate the detectability of anomalous connection in pancreatobiliary disease (ACPBD) cases, measuring gallbladder wall blood flow (GWBF).METHODS: In the retrospective study, we enrolled 42subjects with gallb...AIM: To estimate the detectability of anomalous connection in pancreatobiliary disease (ACPBD) cases, measuring gallbladder wall blood flow (GWBF).METHODS: In the retrospective study, we enrolled 42subjects with gallbladder wall thickening. GWBF velocity was determined as an average value of the peak velocity of color signals on the gallbladder wall, three times in each case. Based on the findings on endoscopic ultrasonography (EUS) or endoscopic retrograde cholangiopancreatography (ERCP), the 42 subjects were divided into 11 cases with ACPBD and 31 cases without ACPBD. In the prospective study, the subjects were 92 cases with gallbladder wall thickening. Using the cut-off level of the flow velocity obtained in the retrospective study, the usefulness of measuring GWBF velocity in diagnosing ACPBD was evaluated.RESULTS: In the retrospective study, imaging of GWBF was obtained in 40 of the 42 subjects. The mean GWBF velocity of the ACPBD cases was 29.4±3.9 cm/s(mean±SD), which was significantly different (P＜0.0001;95% CI 5.48-13.2) from that of the without ACPBD cases(20.1±5.9 cm/s). Based on this result, we prepared a receiver operating characteristic curve, and the cut-off level appropriate for diagnosing ACPBD was estimated to be 25 cm/s. In the prospective study, GWBF was detected in 86 of the 92 subjects. Based on the EUS or ERCP findings, the 92 subjects were divided into 15 cases with ACPBD and 77 cases without ACPBD. When a cut-off level of 25 cm/s was employed, ACPBD could be diagnosed with a sensitivity of 87.0% (13/15) and a specificity of87.3% (62/71).CONCLUSION: Measurement of GWBF velocity, which is less invasive and provides objective values, is very useful for diagnosing ACPBD prior to the development of malignant tumors in cases with gallbladder wall thickening.展开更多
AIM: To assess the usefulness of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) for lymph node metastasis in pancreatobiliary carcinoma.METHODS: All patients suspected of pancreatobiliary carcinoma wit...AIM: To assess the usefulness of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) for lymph node metastasis in pancreatobiliary carcinoma.METHODS: All patients suspected of pancreatobiliary carcinoma with visible lymph nodes after standard EUS between June, 2009 and January, 2012 were enrolled. In the primary analysis, patients with successful EUS-fine needle aspiration (FNA) were included. The lymph nodes were assessed by several standard EUS variables (short and long axis lengths, shape, edge characteristic and echogenicity), color Doppler EUS variable [central intranodal blood vessel (CIV) presence] and CH-EUS variable (heterogeneous/homogeneous enhancement patterns). The diagnostic accuracy relative to EUS-FNA was calculated. In the second analysis, N-stage diagnostic accuracy of CH-EUS was compared with EUS-FNA in patients who underwent surgical resection.RESULTS: One hundred and nine patients (143 lymph nodes) fulfilled the criteria. The short axis cut-off ≥ 13 mm predicted malignancy with a sensitivity and specificity of 72% and 85%, respectively. These values were 72% and 63% for the long axis cut-off ≥ 20 mm, 62% and 75% for the round shape variable, 81% and 30% for the sharp edge variable, 66% and 61% for the hypoechogenicity variable, 70% and 72% for the CIV-absent variable, and 83% and 91% for the heterogeneous CH-EUS-enhancement variable, respectively. CH-EUS was more accurate than standard and color Doppler EUS, except the short axis cut-off. Notably, three patients excluded because of EUS-FNA failure were correctly N-staged by CH-EUS.CONCLUSION: CH-EUS complements standard and color Doppler EUS and EUS-FNA for assessment of lymph node metastases.展开更多
Aim： To determine if there are different penile hemodynamic patterns between sildenafil non-responders and responders by using color Doppler ultrasonography. Methods： A total of 69 erectile dysfunction （ED） patien...Aim： To determine if there are different penile hemodynamic patterns between sildenafil non-responders and responders by using color Doppler ultrasonography. Methods： A total of 69 erectile dysfunction （ED） patients aged 22-79 years were enrolled into the present study. Thirty-eight （55.1%） men with ED who did not respond to four attempts of treatment with 100 mg sildenafil after re-education were classified as sildenafil non-responders. A com- bination of three vasodilator drugs, 1.25 mg papaverine, 0.4 mg phentolamine and 5 ug prostaglandin E1, was given by intracavernous injection before penile Doppler ultrasonography was carried out. The erectile response to intracavernous injection and vascular parameters including peak systolic velocity （PSV）, resistance index （RI）, end diastolic velocity （EDV） and cavernosa artery diameter （CD） were measured and the results between sildenafil nonresponders and responders were compared. Results： No statistical difference in vascular parameters measured by Doppler ultrasonography studies between non-responders and responders was noted. Sildenafil non-responders had a poorer penile rigidity response to intracavernous injection than responders （P 〈 0.05）. Among patients with adequate PSV （〉 30 cm/s） and abnormal EDV （〉 5 cm/s）, individuals in the non-responder group had fewer positive responses to intracavernous vasodilator injection than in the responder group （35.3% vs. 72.2%, P 〈 0.05）. Advanced age and comorbidity with diabetes mellitus were significantly associated with sildenafil non-response （P 〈 0.05）. Conclusion： Sildenafil non-responders were characterized by a poorer penile rigidity response to intracavernous injection and had an associated impaired veno-occlusive mechanism. Advanced age and comorbidity with diabetes mellitus were two common factors associated with non-response.展开更多
Objective: To assess the value of intraoperative ultra- sonography in hepatobiliary surgery. Methods: Aloka-650 and Aloka-500 with a 3.5 MHz probe were used in preoperative uitrasonography and those with 5 MHz or 7.5 ...Objective: To assess the value of intraoperative ultra- sonography in hepatobiliary surgery. Methods: Aloka-650 and Aloka-500 with a 3.5 MHz probe were used in preoperative uitrasonography and those with 5 MHz or 7.5 MHz probes in intraopera- tive ultrasonography. All patients with carcinoma were confirmed pathologically. Results: In 44 patients with liver cancer (76 tumors), the diagnostic rate of intraoperative ultra- sonography was 97% (74/76), which was markedly higher than 84% (64/76) of preoperative ultra- sonography (P<0.05). The diagnostic rate (92%; 22/24) of intraoperative ultrasonography for tumors ≤2 cm in diameter was markedly higher than that (54%; 13/24) of preoperative ultrasonography (P< 0.01). The diagnostic rate (94%; 16/17) of intra- operative ultrasonography for tumor embulus of the vein was also markedly higher than that (53%; 9/ 17) of preoperative ultrasonography (P<0.01). The diagnostic rates of intraoperative and preoperative ultrasonography for cholelithiasis were 99% (108/ 109) and 97% (106/109) respectively (P>0.05). Yet the diagnostic rate (100%; 12/12) of intraopera- tive ultrasonography for gallbladder carcinoma was markedly higher than that (66.7%; 8/12) of pre- operative ultrasonography (P<0.05). The diagnos- tic rates of intraoperative ultrasonography for chole- docholith and biliary tract cancer were all 100%, markedly higher than those (83%; 20/24 and 75%; 12/16) of preoperative ultrasonography (P<0.05). Conclusions: Intraoperative ultrasonography can raise the detective rate of the liver occupying lesions comparing with that of preoperative untrasonogra- phy. It is of valuable in selecting operative scheme and locating small lesions.展开更多
A 38-year-old woman was referred to our institution due to epigastralgia. She presented with obstructive jaundice and eosinophilia. Endoscopic retrograde cholangiopancreatography showed diffuse narrowing from the dist...A 38-year-old woman was referred to our institution due to epigastralgia. She presented with obstructive jaundice and eosinophilia. Endoscopic retrograde cholangiopancreatography showed diffuse narrowing from the distal common bile duct to the bifurcation of the hepatic ducts. An endoscopic plastic biliary stent was inserted; the specimen obtained from the common bile duct wall revealed dense infiltration by eosinophils. Treatment was started with prednisolone 60 mg daily. The patient's biliary stenosis and eosinophilia gradually improved. Eosinophilic infiltration in the lungs or stomach is relatively common, but it is rare in the common bile duct. Most of the reported cases of eosinophilic cholangitis presented with eosinophilia; our patient's eosinophil count was over 1000/mm3. Since our patient had allergies to pollen and house dust, a relationship between the allergies and the eosinophilic cholangitis was suspected, but no cause was identified.展开更多
文摘Endoscopic ultrasonography(EUS)represents the combination of endoscopy and intraluminal ultrasonography.This allows use of a high-frequency transducer(5-20 MHz)that,due to the short distance to the target lesion,provides ultrasonographic images of higher resolution than those obtained from other imaging modalities,including multiple-detector-row-computed tomography,magnetic resonance imaging,and positron emission tomography.EUS is now a widely accepted modality for diagnosing pancreatic diseases.However,the most important limitation of EUS has been the lack of specificity in differentiating between benign and malignant changes.In 1992,EUS-guided fine needle aspiration(FNA)of lesions in the pancreas head was introduced into clinical practice,using a curved linear-array echoendoscope.Since then,EUS has evolved from EUS imaging to EUSFNA and wider applications.Interventional EUS for pancreatic cancer includes EUS-FNA,EUS-guided fine needle injection,EUS-guided biliary drainage and anastomosis,EUS-guided celiac neurolysis,radiofrequency ablation,brachytherapy,and delivery of a growing number of anti-tumor agents.This review focuses on interventional EUS,including EUS-FNA and therapeutic EUS for pancreatic cancer.
文摘Ultrasound has long been an essential tool in nephrology,traditionally used for procedures like vascular access and kidney biopsies.Point-of-care ultrasonography(POCUS),a rapidly evolving bedside technology,is now gaining momentum in nephrology by providing real-time imaging to enhance physical examination findings.Unlike comprehensive radiology-performed ultrasound,POCUS focuses on specific clinical questions,providing immediate and actionable insights.This narrative review examines the philosophy behind POCUS,its expanding applications in nephrology,and its impact on patient care,including its role in diagnosing obstructive uropathy,guiding fluid management,and evaluating hemodynamics in cardiorenal syndrome.Additionally,the review addresses barriers to widespread adoption,such as the need for structured training,competency validation,and interdisciplinary cooperation.By integrating POCUS into routine practice,nephrologists can refine diagnostic accuracy,improve patient outcomes,and strengthen the role of bedside medicine.
基金Supported by Zhejiang Provincial Medical and Health Science and Technology Project,No.2022-KY1-001-198.
文摘BACKGROUND Esophageal bronchogenic cysts(EBCs)are usually discovered incidentally during radiologic or endoscopic examinations.They are rare and prone to misdiagnosis or mistreatment.As a submucosal lesion,the endoscopic ultrasonography(EUS)characteristics of EBCs are unclear.AIM To analyze the clinicopathological and EUS characteristics of EBCs.METHODS A total of 22 patients with a histological diagnosis of EBCs who underwent EUS examination were retrospectively included.The clinicopathological and EUS features were collected and analyzed.RESULTS Most of the EBCs were asymptomatic,and no malignant transformation or precancerous changes was found histologically.Most of the EBCs were located in the lower esophagus(72.7%,16/22).A total of 90.9%(20/22)of the EBCs originated from the muscularis propria,and 9.1%(2/22)originated from the submucosa.All of the lesions had clear boundaries.In terms of echo,77.3%(17/22)had a hypoechoic pattern,and 22.7%(5/22)had an anechoic pattern.We found floating echoes inside the lesion,which presented as a punctiform hyperecho in 45.5%(10/22)and a flocculent hypoecho in 36.4%(8/22)of the patients.A total of 45.5%(10/22)displayed posterior wall enhancement.Fourteen patients underwent color doppler,and no blood flow signal was identified.On EUS elastography,the EBCs presented a yellow-green or green pattern(100%,6/6).When contrast-enhanced EUS was used,the EBCs showed no enhancement(100%,5/5).CONCLUSION When a submucosal lesion located at the lower esophagus originates from the intrinsic muscle layer,the possibility of EBCs should be noted,the EUS characteristics of which include a hypoecho with a clear boundary and a posterior wall enhancement,a floating echo inside and no blood flow signal,a yellow-green or green pattern on elastography,and no enhancement on contrast EUS.
文摘BACKGROUND Magnetic resonance imaging(MRI)and endoscopic ultrasonography(EUS)are recommended in combination for screening pancreatic cancer in high-risk individuals.However,in clinical practice,MRI and EUS are increasingly utilized for pancreatic surveillance during routine health examinations.AIM To investigate the feasibility of these imaging modalities for screening in low-risk individuals.METHODS This retrospective study included patients at low risk for pancreatic cancer who underwent MRI or EUS at two health evaluation centers between March 2019 and December 2024.Basic characteristics,laboratory data,and imaging results were collected.RESULTS A total of 3364 low-risk individuals underwent pancreatic screening:1553(46.1%)received MRI,and 1811 underwent EUS.No significant differences were observed in age or sex distribution between the groups.In imaging screening,EUS demonstrated a higher detection rate of abnormal pancreatic lesions(12.8%vs 2.6%;P<0.001).MRI detected more cystic lesions than did EUS(P<0.001).EUS identified smaller nodular lesions compared to MRI(9.2 mm vs 18.0 mm;P=0.044).The MRI group had a higher number of confirmed intraductal papillary mucinous neoplasms(P=0.031),whereas the EUS group identified more suspected branch-duct intraductal papillary mucinous neoplasms(P<0.001).Pancreatic adenocarcinoma was found in three patients(0.08%),with no significant difference in detection rates between EUS and MRI(0.11%vs 0.06%;P=0.656).CONCLUSION In low-risk individuals,MRI and EUS offer comparable effectiveness for pancreatic cancer surveillance.The choice of imaging strategy for health evaluation depends on cost considerations and degree of invasiveness.
文摘BACKGROUND Appendicitis is an abdominal medical emergency and can be of various types.It can lead to a series of gastrointestinal symptoms and can affect health status.Therefore,attention should be paid to the diagnosis of appendicitis to improve prognosis.AIM To assess the value of transabdominal superficial ultrasonography(TASU)in the clinical diagnosis of various types of appendicitis.METHODS A total of 100 patients suspected to have acute appendicitis that were admitted to our hospital between July 2022 and July 2024 were selected for this study.All of them underwent conventional abdominal ultrasonography and TASU.Taking surgical pathology as the gold standard,the diagnostic efficacy of the two ultrasonographic examinations was compared,and the ultrasonographic features of patients with different types of appendicitis were analyzed.RESULTS Comparison with the gold standard showed that among the 100 patients suspected of appendicitis,72 cases were diagnosed as appendicitis while 28 cases were deemed to be normal.Compared with conventional abdominal ultrasonography,TASU displayed a higher diagnostic efficiency(P<0.05).Among the 72 patients with acute appendicitis,22 cases were diagnosed as simple appendicitis,26 cases as suppurative appendicitis,and 24 cases as gangrenous appendicitis.TASU was more effective in the diagnosis of the various types of appendicitis,and the difference was significant between groups(P<0.05).Ultrasonography radiographs revealed an enlarged appendix with a tubular anechoic area,a widened lumen,with a visible occlusion or stercoral shadow and a cystic mass in the parenchyma.CONCLUSION TASU can accurately diagnose appendicitis and also be used to identify the various types of appendicitis,thereby having application value.
基金Supported by the University of Kelaniya Grant,No.RP/03/04/11/01/2011.
文摘BACKGROUND Routine assessment of solid gastric emptying is challenging due to the prolonged test duration and complex meal preparation.Replacing solid test meals with easily prepared,commercially available semisolid meals and shortening the test duration can significantly enhance the feasibility and practicality of gastric emptying evaluations.AIM To compare the gastric emptying and antral motility of solid vs semi-solid meals of similar volume and nutritional consistency,and to assess the feasibility of meal substitution and reduction in test duration during the solid gastric emptying assessment.METHODS Thirty healthy volunteers(17 males,age:29.4±6.0 years,body mass index:23.4±2.94 and 13 females,age:37.2±11.9 years,body mass index:22.9±4.34)underwent gastric emptying by real-time ultrasonography after a solid meal and a comparable commercially prepared semi-solid meal(each meal,total calorie 350 kcal,carbohydrates 60%,fat 30%and proteins 10%),on separate dates 1 week apart.The gastric antral area was measured at 5 minutes,15 minutes,30 minutes,45 minutes,60 minutes,90 minutes,120 minutes,150 minutes,180 minutes,210 minutes,and 240 minutes post-ingestion using a previously validated technique and compared between meals.RESULTS Mean and median antral areas,gastric emptying rates,gastric residual ratios,and motility index at each time point were almost similar between meals for up to 3 hours.At the end of 4 hours,the mean emptied percentage of the semisolid meal and solid meal was 81.1%and 70.6%,respectively.The emptying rate of the semisolid meal at 90 minutes significantly correlated with that of 240 minutes.There was no correlation between the solid meal emptying rates at 90 minutes and 240 minutes.CONCLUSION Gastric emptying,residual antral cross-sectional area and antral motility of a semisolid meal are almost similar to that of a solid meal of the same nutritional value until three hours post-ingestion.A semisolid test meal can effectively substitute a solid test meal during ultrasound assessment of gastric emptying,without compromising the validity of the results.Additionally,the ease of preparation and administration of semisolid meals enhances the overall feasibility of gastric emptying assessments.
文摘BACKGROUND The diagnosis of gastric inflammatory fibroid polyps(IFPs)mainly depends on pathological confirmation after endoscopic or surgical treatment.Gastric IFP have typical manifestations under endoscopic ultrasonography(EUS),but atypical EUS features have also been reported.Previous studies have found that atypical features of gastric IFPs observed under EUS have corresponding histological manifestations.At present,there is no study elaborating the EUS manifestations of gastric IFPs at different pathological stages.We hypothesize that gastric IFPs at different pathological stages may have different EUS features.AIM To describe EUS features of gastric IFPs and compare with their pathological characteristics.METHODS Clinical data of 53 inpatients with pathologically diagnosed gastric IFPs after endoscopic treatment were collected.All patients underwent preoperative EUS.We analyzed the EUS characteristics of the lesions and compared with the pathological characteristics and staging of the resected specimens.RESULTS Most gastric IFPs showed medium-low echo(67.9%),homogeneous echo(90.6%),and unclear boundaries(83%),and involved the second and third layers of the gastric wall(69.8%)under EUS.The echogenicity level and echo homogeneity were significantly correlated with the pathological stage of gastric IFP.Gastric IFPs in the nodular stage presented hypoechoic and homogeneous echo.Gastric IFPs in the fibrovascular stage mostly showed medium-low echo and homogeneous echo.Gastric IFPs in the sclerotic stage showed different echogenicity levels and echo homogeneity.The accuracy of EUS in diagnosing gastric IFPs was 66.0%(35/53),and the accuracy in determining the origin layer of gastric IFPs was 73.4%(39/53).CONCLUSION Gastric IFPs at different pathological stages have different EUS features.In order to improve the diagnostic rate,it is necessary to combine EUS with EUS-guided fine-needle aspiration or artificial intelligence.
文摘Diaphragmatic function is central to respiration,and its evaluation is critical in intensive care unit(ICU)settings.Ultrasonography is a reliable bedside tool to assess diaphragmatic excursion(DE).[1,2]The conventional M-mode(MM)offers high-resolution imaging but requires precise alignment,which can be diffi cult in ICU patients.[3-5]Anatomical M-mode(AMM)allows flexible line adjustment,enabling accurate DE measurements despite poor acoustic windows.[6]However,comparative data between MM and AMM are limited.This retrospective study evaluated the concordance between MM and AMM for assessing right DE.
文摘BACKGROUND Early detection of acute appendicitis(AA)in pediatric cases,critical to avoiding life-threatening complications such as perforation or abscess,remains challenging.AIM To evaluate the utility of abdominal ultrasonography(AUS)in diagnosing pediatric AA.METHODS Overall,102 pediatric patients(aged 3-12 years)suspected of having AA were enrolled and divided into the AA(n=78)and non-AA(n=24)groups.All children underwent AUS and computed tomography(CT).Comparative analyses regarding general patient characteristics and appendix-specific parameters were conducted.The diagnostic performance of AUS and CT in pediatric AA was evaluated.RESULTS All appendix-related parameters were greater in the AA group than in the non-AA group.The areas under the receiver-operating characteristic curves for pediatric AA diagnosis using AUS,CT,and AUS+CT were 0.870,0.824,and 0.931(all P<0.001),respectively(AUS:94.87%sensitivity,79.17%specificity;CT:89.74%sensitivity,75.00%specificity;combined:98.72%sensitivity,87.50%specificity).The positive predictive value(PPV),negative predictive value(NPV),accuracy rate,positive detection rate,and misdiagnosis rate of AUS were 93.67%,82.61%,91.18%,72.55%,and 20.83%,respectively.CT had a slightly lower PPV(92.11%)and NPV(69.23%),along with accuracy,positive detection,and misdiagnosis rates of 86.27%,68.63%,and 25%,respectively.Their combination improved performance,yielding 96.25%PPV,95.45%NPV,96.08%accuracy,75.49%positive detection rate,and 12.50%misdiagnosis rate.CONCLUSION AUS demonstrates certain diagnostic potential in AA diagnosis in pediatric patients,and its combination with CT further improves diagnostic efficacy.
文摘An abrupt decline in respiratory function often presents in patients unable to undergo imaging procedures,especially in critical care settings.Consequently,evaluation using transthoracic lung ultrasonography has been developed to promptly diagnose the patient's respiratory conditions at bedside,gaining increasing attention for its utility.However,conventional transthoracic ultrasonography may face challenges in directly accessing the thorax.
文摘Both endoscopic ultrasonography(EUS)-guided choledochoduodenostomy( EUS- CDS) and EUS-guided hepaticogastrostomy(EUS-HGS) are relatively well established as alternatives to percutaneous transhepatic biliary drainage(PTBD). Both EUSCDS and EUS-HGS have high technical and clinical success rates(more than 90%) in high-volume centers. Complications for both procedures remain high at 10%-30%. Procedures performed by endoscopists who have done fewer than 20 cases sometimes result in severe or fatal complications. When learning EUSguided biliary drainage(EUS-BD), we recommend a mentor's supervision during at least the first 20 cases. For inoperable malignant lower biliary obstruction, a skillful endoscopist should perform EUS-BD before EUS-guided rendezvous technique(EUS-RV) and PTBD. We should be select EUS-BD for patients having altered anatomy from malignant tumors before balloon-enteroscope-assisted endoscopic retrograde cholangiopancreatography, EUS-RV, and PTBD. If both EUS-CDS and EUS-HGS are available, we should select EUS-CDS, according to published data. EUSBD will potentially become a first-line biliary drainage procedure in the near future.
文摘Ultrasonography(US) and the new applications US elastography(USE) and contrast-enhanced US(CEUS) are used in the screening of thyroid nodules,for which fine-needle aspiration biopsy(FNAB) is the best single diagnostic test.The aim of the study was to compare the sensitivity,specificity,positive predictive value(PPV),and accuracy of the four examinations in nodules with cytological and histological diagnoses.The study used data from US,FNAB,USE(elasticity(ELX 2/1) index),and CEUS(Peak index and time to peak(TTP) index) evaluated in 73 thyroid nodules in 63 consecutive patients likely to undergo surgery.Cytological-histological correlation was available for 38 nodules.No correlation emerged between nodule size and cytological results.A significant(P=0.03) positive correlation between cumulative US findings and cytological results was found.In addition,significant correlations between cumulative US findings and cytology(P=0.02) and between cumulative US findings and histology(P<0.0001) were found.US showed the best specificity and PPV,and FNAB the best sensitivity.There was no significant difference in the ELX 2/1 index,Peak index,or TTP index among nodules subdivided according to cytological scores.No significant correlation was found between ELX 2/1 index,Peak index,and TTP index,on the one hand,and nodule size,US cumulative findings,cytology,and histology on the other hand.The sensitivity of the ELX 2/1 index was high,but its specificity was very low.The accuracy and PPV of USE were lower than those of the other procedures.Only the correlation between Peak index and cumulative US findings reached a value close to significance.Our ultimate aim is to minimise unnecessary thyroidectomy.US and FNAB continue to play a central diagnostic role.The use of a US score showed high specificity and PPV.The specificity of FNAB was low in this selected series because of the numbers of indeterminate cytological responses.USE and CEUS are innovative techniques that need to be standardized.The ELX 2/1 index,Peak index,and TTP index seem to be unrelated to histology.The best statistical data on USE and CEUS concerned their sensitivity and PPV,respectively.At present,USE and CEUS are too time-consuming and of limited utility in selecting patients for surgery.
文摘AIM:To evaluate the detection and differentiation ability of contrast-enhanced intraoperative ultrasonography(CE-IOUS) in hepatocellular carcinoma(HCC) operations.METHODS:Clinical data of 50 HCC patients were retrospective analyzed.The sensitivity,specificity,false negative and false positive rates of contrast enhanced magnetic resonance imaging(CE-MRI),IOUS and CEIOUS were calculated and compared.Surgical strategy changes due to CE-IOUS were analyzed.RESULTS:Lesions detected by CE-MRI,IOUS and CEIOUS were 60,97 and 85 respectively.The sensitivity,specificity,false negative rate,false positive rate of CEMRI were 98.2%,98.6%,98.6%,60.0%,respectively;for IOUS were 50.0%,90.9%,1.8%,1.4%,respectively;and for CE-IOUS were 1.4%,40.0%,50.0%,9.1%,respectively.The operation strategy of 9(9/50,18.0%) cases was changed according to the results of CE-IOUS.CONCLUSION:Compared with CE-MRI,CE-IOUS performs better in detection and differentiation of small metastasis and regenerative nodules.It plays an important role in the decision-making of HCC operation.
文摘Endoscopic ultrasonography(EUS) is a technique with an established role in the diagnosis and staging of gastro-intestinal tumors. In recent years, the spread of new devices dedicated to tissue sampling has improved the diagnostic accuracy of EUS fine-needle aspiration. The development of EUS-guided drainage of the biliopancreatic region and abdominal fluid collections has allowed EUS to evolve into an interventional tool that can replace more invasive procedures. Emerging techniques applying EUS in pancreatic cancer treatment and in celiac neurolysis have been described. Recently, confocal laser endomicroscopy has been applied to EUS as a promising technique for the in vivo histological diagnosis of gastro-intestinal, bilio-pancreatic and lymph node lesions. In this state-of-the-art review, we report the most recent data from the literature regarding EUS devices, interventional EUS, EUS-guided confocal laser endomicroscopy and EUS pancreatic cancer treatment, and we also provide an overview of their principles, clinical applications and limitations.
文摘Contrast agents are increasingly being used to characterize the vasculature in an organ of interest,to better delineate benign from malignant pathology and to aid in staging and directing therapeutic procedures.We review the mechanisms of action of first,second and third generation contrast agents and their use in various endoscopic procedures in the gastrointestinal tract.Various applications of contrast-enhanced endoscopic ultrasonography include differentiating benign from malignant mediastinal lymphadenopathy,assessment of depth of invasion of esophageal,gastric and gall bladder cancers and visualization of the portal venous system and esophageal varices.In addition,contrast agents can be used to differentiate pancreatic lesions.The use of color Doppler further increases the ability to diagnose and differentiate various pancreatic malignancies.The sensitivity of power Doppler sonography to depict tumor neovascularization can be increased by contrast agents.Contrast-enhanced harmonic imaging is a useful aid in identifying the tumor vasculature and studying pancreatic microperfusion.In the future,these techniques could potentially be used to quantify tumor perfusion,to assess and monitor the efficacy of antiangiogenic agents,to assist targeted drug delivery and allow molecular imaging.
文摘AIM: To estimate the detectability of anomalous connection in pancreatobiliary disease (ACPBD) cases, measuring gallbladder wall blood flow (GWBF).METHODS: In the retrospective study, we enrolled 42subjects with gallbladder wall thickening. GWBF velocity was determined as an average value of the peak velocity of color signals on the gallbladder wall, three times in each case. Based on the findings on endoscopic ultrasonography (EUS) or endoscopic retrograde cholangiopancreatography (ERCP), the 42 subjects were divided into 11 cases with ACPBD and 31 cases without ACPBD. In the prospective study, the subjects were 92 cases with gallbladder wall thickening. Using the cut-off level of the flow velocity obtained in the retrospective study, the usefulness of measuring GWBF velocity in diagnosing ACPBD was evaluated.RESULTS: In the retrospective study, imaging of GWBF was obtained in 40 of the 42 subjects. The mean GWBF velocity of the ACPBD cases was 29.4±3.9 cm/s(mean±SD), which was significantly different (P＜0.0001;95% CI 5.48-13.2) from that of the without ACPBD cases(20.1±5.9 cm/s). Based on this result, we prepared a receiver operating characteristic curve, and the cut-off level appropriate for diagnosing ACPBD was estimated to be 25 cm/s. In the prospective study, GWBF was detected in 86 of the 92 subjects. Based on the EUS or ERCP findings, the 92 subjects were divided into 15 cases with ACPBD and 77 cases without ACPBD. When a cut-off level of 25 cm/s was employed, ACPBD could be diagnosed with a sensitivity of 87.0% (13/15) and a specificity of87.3% (62/71).CONCLUSION: Measurement of GWBF velocity, which is less invasive and provides objective values, is very useful for diagnosing ACPBD prior to the development of malignant tumors in cases with gallbladder wall thickening.
基金Supported by Grants from the Japan Society for the Promotion of Science and the Japanese Foundation for the Research and Promotion of Endoscopy,No.22590764 and No.25461035
文摘AIM: To assess the usefulness of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) for lymph node metastasis in pancreatobiliary carcinoma.METHODS: All patients suspected of pancreatobiliary carcinoma with visible lymph nodes after standard EUS between June, 2009 and January, 2012 were enrolled. In the primary analysis, patients with successful EUS-fine needle aspiration (FNA) were included. The lymph nodes were assessed by several standard EUS variables (short and long axis lengths, shape, edge characteristic and echogenicity), color Doppler EUS variable [central intranodal blood vessel (CIV) presence] and CH-EUS variable (heterogeneous/homogeneous enhancement patterns). The diagnostic accuracy relative to EUS-FNA was calculated. In the second analysis, N-stage diagnostic accuracy of CH-EUS was compared with EUS-FNA in patients who underwent surgical resection.RESULTS: One hundred and nine patients (143 lymph nodes) fulfilled the criteria. The short axis cut-off ≥ 13 mm predicted malignancy with a sensitivity and specificity of 72% and 85%, respectively. These values were 72% and 63% for the long axis cut-off ≥ 20 mm, 62% and 75% for the round shape variable, 81% and 30% for the sharp edge variable, 66% and 61% for the hypoechogenicity variable, 70% and 72% for the CIV-absent variable, and 83% and 91% for the heterogeneous CH-EUS-enhancement variable, respectively. CH-EUS was more accurate than standard and color Doppler EUS, except the short axis cut-off. Notably, three patients excluded because of EUS-FNA failure were correctly N-staged by CH-EUS.CONCLUSION: CH-EUS complements standard and color Doppler EUS and EUS-FNA for assessment of lymph node metastases.
文摘Aim： To determine if there are different penile hemodynamic patterns between sildenafil non-responders and responders by using color Doppler ultrasonography. Methods： A total of 69 erectile dysfunction （ED） patients aged 22-79 years were enrolled into the present study. Thirty-eight （55.1%） men with ED who did not respond to four attempts of treatment with 100 mg sildenafil after re-education were classified as sildenafil non-responders. A com- bination of three vasodilator drugs, 1.25 mg papaverine, 0.4 mg phentolamine and 5 ug prostaglandin E1, was given by intracavernous injection before penile Doppler ultrasonography was carried out. The erectile response to intracavernous injection and vascular parameters including peak systolic velocity （PSV）, resistance index （RI）, end diastolic velocity （EDV） and cavernosa artery diameter （CD） were measured and the results between sildenafil nonresponders and responders were compared. Results： No statistical difference in vascular parameters measured by Doppler ultrasonography studies between non-responders and responders was noted. Sildenafil non-responders had a poorer penile rigidity response to intracavernous injection than responders （P 〈 0.05）. Among patients with adequate PSV （〉 30 cm/s） and abnormal EDV （〉 5 cm/s）, individuals in the non-responder group had fewer positive responses to intracavernous vasodilator injection than in the responder group （35.3% vs. 72.2%, P 〈 0.05）. Advanced age and comorbidity with diabetes mellitus were significantly associated with sildenafil non-response （P 〈 0.05）. Conclusion： Sildenafil non-responders were characterized by a poorer penile rigidity response to intracavernous injection and had an associated impaired veno-occlusive mechanism. Advanced age and comorbidity with diabetes mellitus were two common factors associated with non-response.
文摘Objective: To assess the value of intraoperative ultra- sonography in hepatobiliary surgery. Methods: Aloka-650 and Aloka-500 with a 3.5 MHz probe were used in preoperative uitrasonography and those with 5 MHz or 7.5 MHz probes in intraopera- tive ultrasonography. All patients with carcinoma were confirmed pathologically. Results: In 44 patients with liver cancer (76 tumors), the diagnostic rate of intraoperative ultra- sonography was 97% (74/76), which was markedly higher than 84% (64/76) of preoperative ultra- sonography (P<0.05). The diagnostic rate (92%; 22/24) of intraoperative ultrasonography for tumors ≤2 cm in diameter was markedly higher than that (54%; 13/24) of preoperative ultrasonography (P< 0.01). The diagnostic rate (94%; 16/17) of intra- operative ultrasonography for tumor embulus of the vein was also markedly higher than that (53%; 9/ 17) of preoperative ultrasonography (P<0.01). The diagnostic rates of intraoperative and preoperative ultrasonography for cholelithiasis were 99% (108/ 109) and 97% (106/109) respectively (P>0.05). Yet the diagnostic rate (100%; 12/12) of intraopera- tive ultrasonography for gallbladder carcinoma was markedly higher than that (66.7%; 8/12) of pre- operative ultrasonography (P<0.05). The diagnos- tic rates of intraoperative ultrasonography for chole- docholith and biliary tract cancer were all 100%, markedly higher than those (83%; 20/24 and 75%; 12/16) of preoperative ultrasonography (P<0.05). Conclusions: Intraoperative ultrasonography can raise the detective rate of the liver occupying lesions comparing with that of preoperative untrasonogra- phy. It is of valuable in selecting operative scheme and locating small lesions.
文摘A 38-year-old woman was referred to our institution due to epigastralgia. She presented with obstructive jaundice and eosinophilia. Endoscopic retrograde cholangiopancreatography showed diffuse narrowing from the distal common bile duct to the bifurcation of the hepatic ducts. An endoscopic plastic biliary stent was inserted; the specimen obtained from the common bile duct wall revealed dense infiltration by eosinophils. Treatment was started with prednisolone 60 mg daily. The patient's biliary stenosis and eosinophilia gradually improved. Eosinophilic infiltration in the lungs or stomach is relatively common, but it is rare in the common bile duct. Most of the reported cases of eosinophilic cholangitis presented with eosinophilia; our patient's eosinophil count was over 1000/mm3. Since our patient had allergies to pollen and house dust, a relationship between the allergies and the eosinophilic cholangitis was suspected, but no cause was identified.
