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
BACKGROUND Diagnosing hyperandrogenemia in postmenopausal women is very difficult.It occasionally manifests as excessive hair growth or with no clinical manifestations,and is therefore often misdiagnosed or missed alt...BACKGROUND Diagnosing hyperandrogenemia in postmenopausal women is very difficult.It occasionally manifests as excessive hair growth or with no clinical manifestations,and is therefore often misdiagnosed or missed altogether.Ovarian steroid cell tumors that cause hyperandrogenemia in women account for approximately 0.1%of all ovarian tumors.Due to the low incidence,corresponding imaging reports are rare,so ovarian steroid cell tumors lacks typical imaging findings to differ-entiate it from other ovarian tumors.Therefore,we summarized its clinical and imaging characteristics through this case series,and elaborated on the differential diagnosis of steroid cell tumors.CASE SUMMARY We report three cases of postmenopausal women with hyperandrogenemia.Only 1 patient showed virilization symptoms,the other two patients were completely asymptomatic.All patients underwent total hysterectomy+bilateral adnexe-ctomy.Histological results showed one case of Leydig cell tumor and two cases of benign,non-specific steroid cell tumor.After the operation,the androgen levels of all patients returned to normal,and there was no clinical recurrence since follow-up.CONCLUSION Although virilization caused by increased serum testosterone levels is an important clinical feature of ovarian steroid cell tumors,it is often asymptomatic.A solid,slightly hypoechoic,round or oval mass with uniform internal echo,richer blood flow in the solid part,and low resistance index are typical imaging features of ovarian steroid cell tumors.Diagnosis of ovarian steroid cell tumors after menopause is challenging,but surgery can be used for both diagnosis and clear treatment.展开更多
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.
基金National Natural Science Foundation of China,No.81971623,and No.82027803.
文摘BACKGROUND Diagnosing hyperandrogenemia in postmenopausal women is very difficult.It occasionally manifests as excessive hair growth or with no clinical manifestations,and is therefore often misdiagnosed or missed altogether.Ovarian steroid cell tumors that cause hyperandrogenemia in women account for approximately 0.1%of all ovarian tumors.Due to the low incidence,corresponding imaging reports are rare,so ovarian steroid cell tumors lacks typical imaging findings to differ-entiate it from other ovarian tumors.Therefore,we summarized its clinical and imaging characteristics through this case series,and elaborated on the differential diagnosis of steroid cell tumors.CASE SUMMARY We report three cases of postmenopausal women with hyperandrogenemia.Only 1 patient showed virilization symptoms,the other two patients were completely asymptomatic.All patients underwent total hysterectomy+bilateral adnexe-ctomy.Histological results showed one case of Leydig cell tumor and two cases of benign,non-specific steroid cell tumor.After the operation,the androgen levels of all patients returned to normal,and there was no clinical recurrence since follow-up.CONCLUSION Although virilization caused by increased serum testosterone levels is an important clinical feature of ovarian steroid cell tumors,it is often asymptomatic.A solid,slightly hypoechoic,round or oval mass with uniform internal echo,richer blood flow in the solid part,and low resistance index are typical imaging features of ovarian steroid cell tumors.Diagnosis of ovarian steroid cell tumors after menopause is challenging,but surgery can be used for both diagnosis and clear treatment.
