【Abstract】ObjectiveTo evaluate the role of MRA, IPVG and DUS in the hemodynamics studies of portal hypertension. MethodsThirtyeight patients with portal hypertension were examined with Philips Gyroscan 1.0 Tesla MR imaging system. 3DDCE MRA and 2DPC MR were used for study of portal venous anatomy and its hemodynamics. The results were compared with those obtained from IPVG and DUS. Results3DDCE MRA could clearly display the anatomical imaging of portal venous system and its imaging quality was better than that of IPVG. The data of hemodynamics from 2DPC MR including diameter, blood velocity and blood flow were closely correlated to those from DUS. ConclusionAs a noninvasive technique, MRA can display the anatomy of portal venous system and measure its hemodynamics exactly. It should be applied as the first choice in hemodynamics evaluation for portal hypertension.
Objective To determine the accuracy of endorectal ultrasonography (ERUS) in preoperative staging of rectal cancer and investigate the limitations and pitfalls of ERUS. Methods Ninety-four patients with rectal cancer were examined preoperatively by ERUS between September 2008 and November 2009 in this hospital. The size, shape, echo pattern, infiltration depth, and extra-rectal invasion of lesions were observed. The results of ERUS staging were compared with histopathology findings of the resected specimens. Results The overall accuracy of ERUS in T staging was 63.8% (60/94). The accuracies of ERUS for pT1, pT2, pT3, and pT4 tumor were 87.2% (82/94), 76.6% (72/94), 76.6% (72/94), and 97.9% (92/94), respectively. The sensitivity, specificity, and accuracy of ERUS for advanced rectal cancer (pT3+pT4) were 70.8% (34/48), 78.3% (36/46), and 74.5% (70/94), respectively. The sensitivity, specificity, and accuracy of ERUS in lymph node metastasis were 75.0% (42/56), 42.1% (16/38), and 61.7% (58/94), respectively. There was no significant difference of accuracy among various tumor locations above anocutaneous line (P＝0.495). The accuracy of ERUS for T staging improved with experience, the T staging accuracy improved from 40.0% after assessment of 30 cases to 81.3% after 94 cases were examined (P＝0.026). Conclusions The ERUS provides a good accuracy rate for assessment of the depth of tumor invasion and lymph node metastasis of rectal cancer, and has become an important imaging tool for preoperative staging rectal cancer. The operator experience, peritumoral inflammation mainly influences the accuracy of ERUS.
Objective
To probe the significance of application of ultrasound biomicroscopy (UBM) in the diagnosis and management of the iris and ciliary tumors.
Methods
UBM (Mode 840, Humphrey, 50 MHz 5 mm×5 mm) was done in 34 cases (35 eyes) of iris and ciliary body tumors, and some of the affected eyes underwent B-scan or Doppler ultrasound and CT scan. Histopathological examination of the resected tumor tissues was performed in 21 eyes of the operation.
Results
Among this series of 35 eyes with iris and ciliary body tumors detected by UBM, the characteristics of locality and solidity of the tumors, i,e., anterior chamber in plantation cyst, cyst behind the iris, and solid tumors of iris and ciliary body, of 21 eyes undergone surgical treatment revealed the same results both in UBM and histopathological examinations.
Conclusion
UBM can supply precise informations in diagnosis and treatment of tumors of iris and ciliary body.
(Chin J Ocul Fundus Dis, 2002, 18: 128-130)
Objective
To investigate the changes of ocular hemodynamics in patients with retinal vein occlussion(RVO)．
Methods
The hemodynamic parameters(PSV,EDV,PI,Vmax)of central retinal artery(CRA)and central retinal vein(CRV)were measured in the involved eyes(n=48) with RVO and the contralateral clinically healthy eyes(n=39) and in the control eyes(n=40) by color Doppler imaging (CDI)(ATLHDI3000).
Results
Peak systolic velocity (PSV) and end diastolic velocity (EDV) were significantly lower in the CRA of involved eyes and clinically healthy eyes of patients with RVO compared with control eyes,and pulsatility index(PI)was significantly higher in the CRA of involved eyes of patients with RVO compared with control eyes．PSV were significantly lower in the CRA of involved eyes of patients with RVO compared with their clinically healthy eyes．Pulsatility index(PI)was significantly higher in the CRA of involved eyes of patients with RVO compared with their clinically healthy eyes．Maximun vein velocity (Vmax) was significantly lower in the CRV of involved eyes and clinically healthy eyes of patients with RVO compared with control eyes．
Conclusion
The changes of hemodynamics in CRA,CRV of involved eyes of patients with RVO may invade their clinically healthy eyes．CDI may be helpful to early diagnosis for RVO．
(Chin J Ocul Fundus Dis,1998,14:111-113)
ObjectiveTo explore the safety and feasibility of contrast enhanced intraoperative ultrasonographyguided percutaneous radiofrequency ablation with artificial hydrothorax to hepatocellular carcinoma in the hepatic dome. MethodsThe clinical data of nine patients with hepatocellular carcinoma in the hepatic dome underwent ultrasonographyguided percutaneous radiofrequnecy ablation with artificial hydrothorax from January 2008 to June 2009 at Department of Hepatobiliopancreatic Surgery of West China Hospital were retrospectively analyzed. The perioperative results and recurrence of tumor were also analyzed. ResultsAll of nine patients with twelve tumors received successfully radiofrequency ablation with artificial hydrothorax of (2 444±464) ml (2 000-3 000 ml). The ablation time was 12-24 min (median 12 min), with an average of (15±5) min for each tumor. No hemothorax, pneumothorax, and death occurred during operation. One patient had ascites of 2 000 ml after ablation due to hypoalbuminenia, and ascites disappeared by infusion of abumin on 4 d after operation. The total volume of pleural drainage was 250-1 420 ml, with an average of (717±372) ml for each patient, and the drainage tube was withdrawn on 3-5 d after operation. The followup time was 7-23 months (mean 15 months). Tumor recurrence was found in three patients on 5, 6, and 7 months after operation, respectively. Of them, two patients were in stable disease stage after interventional and conservative therapy, respectively, and one case recurred at six months after operation and died of hypertensive heart disease and hepatic function deterioration at sixteen months after operation. The rest patients survived and no recurrence and metastasis was observed during the follow-up period.ConclusionThe technique of percutaneous radiofrequency ablation with artificial hydrothorax increases the feasibility of the minimal invasive treatment for hepatoma, which can be applied to hepatocellular carcinoma in the hepatic dome with high safety and clinical application value.
Objective
To explore the effectiveness of ultrasound-guided percutaneous Herbert screw for the treatment of fresh nondisplaced carpal scaphoid fracture.
Methods
Between May 2013 and August 2015, 15 patients with fresh nondisplaced carpal scaphoid fractures (Krimmer type A2) were treated with ultrasound-guided Herbert screw fixation. There were 12 males and 3 females with an average age of 33.4 years (range, 18-51 years). The causes of injury included 9 cases of falls, 3 cases of training injuries, and 3 cases of machine injuries. The interval from injury to surgery was 2-15 days (mean, 5 days). No other complication was found. The operation time, intraoperative blood loss, intraoperative fluoroscopy times, and the fracture healing time were recorded. The wrist function was assessed by the modified Mayo wrist score standard.
Results
The operation time was 28-53 minutes (mean, 33.9 minutes); the intraoperative blood loss was 5-30 mL (mean, 10.5 mL); the intraoperative fluoroscopy was 2-6 times (mean, 2.6 times). All 15 patients were followed up 6-18 months (mean, 10.5 months). One patient developed pain and soreness in the skin of the nail entrance, and gradually relieved after fumigation. No complication such as infection occurred. All fractures healed clinically, and the healing time was 8-16 weeks (mean, 11.6 weeks). At last follow-up, the modified Mayo wrist score was 76-99 (mean, 92.5). Among them, 12 cases were excellent, 2 cases were good, and 1 case was fair, and the excellent and good rate was 93.3%.
Conclusion
Ultrasound-guided fixation with Herbert screw is a reliable treatment method for fresh nondisplaced carpal scaphoid fractures with small invasion, less bleeding, and small radiation damage.
Objective
To explore the effectiveness of arterial crisis after replantation of limb treated by ultrasound guided Fogarty balloon catheter.
Methods
Between January 2012 and July 2016, 27 patients suffered from arterial crisis after replantation of limb were treated with ultrasound guided Fogarty balloon catheter combined with thrombolytic anticoagulant. There were 18 males and 9 females with the age of 19-51 years (mean, 32 years). The limb mutilation position was at knee joint in 3 cases, lower limb in 9 cases, ankle joint in 6 cases, elbow joint in 2 cases, forearm in 4 cases, and wrist joint in 3 cases. The arterial crisis happened at 2.5-18 hours (mean, 7.5 hours) after limb replantation surgery. Color doppler ultrasonography was used to diagnose the arterial thrombosis, finally the anastomotic thrombosis were found in 16 cases, non-anastomotic thrombosis in 7 cases, and combined thrombosis in 4 cases. All the thrombosis were deteced in the arteries with the length of 0.8-3.9 cm.
Results
No complication such as vascular perforation, rupture, air embolism, thromboembolism, wound infection, or sepsis happened after operation. Arterial crisis occurred again in 3 cases at 1.5-13.5 hours after limb replantation and treated by arterial exploration, 1 case was treated successfully; 2 cases had arterial occlusion and partial necrosis of limb, and got amputation treatment at last. The rest 24 cases survived with the incision healing by first stage. In the 24 cases, 1 case suffered from acute myonephropathic metabolic syndrome and corrected after hemodialysis; 1 case suffered from acute liver functional damage and corrected by comprehensive treatment of internal medicine. The 24 patients were followed up 7-38 months (mean, 11 months). At last follow-up, blood supply of the limb was good with normal skin temperature and improved sense of feeling, activity, and swelling. According to Chinese Medical Association of hand surgery to the upper extremity function assessment standard, the results were excellent in 12 cases, good in 8 cases, and fair in 4 cases with an excellent and good rate of 83.3%.
Conclusion
Ultrasound guided Fogarty balloon catheter treatment of posterior replantation of arterial crisis can accurately locate the thrombosis, get the thrombus fast and invasive minimally to avoid the blind and repeated thrombectomy, and obtain certain effectiveness.
ObjectiveTo evaluate the value of high-frequency color Doppler ultrasonography in the diagnosis of femoral hernia.
MethodsThe ultrasonographic features of 39 femoral hernias in 37 patients treated between March 2008 and October 2013 were retrospectively analyzed, and the results were confirmed by surgery.
ResultsThirty-nine femoral hernias were diagnosed by surgery, including 19 in the right side, 16 in the left side, and 2 with double-side hernias. Thirty-seven femoral hernias were diagnosed with ultrasonography. Two femoral hernias were misdiagnosed as lipoma in one, and as enlarged lymph nodes in one, respectively. Ultrasound diagnosis accurate rate was 94.9% (37/39). Hernia content could be seen through surgery in 28 cases, and the ultrasound accurate rate in assessing the hernia content was 85.7% (24/28).
ConclusionUltrasonography is the first choice for improving the diagnosis efficacy of femoral hernia.
ObjectiveTo investigate the value of contrastenhanced ultrasonography in differential diagnosis between benign and malignant breast mass. MethodsTotally 65 patients with 70 breast masses were evaluated by general ultrasonography and contrastenhanced ultrasonography with contrast agent SonoVue. The related indexes, such as the degree and mode of contrast enhancement, the lesion boundaries and dissipation mode, were used to describe the difference between benign and malignant mass, which was also compared with pathological results. ResultsHistopathological examination revealed that benign mass was in 37 cases and malignant in 28 cases. The sensitivity, accuracy, positive predictive value, and negative predictive value of contrastenhanced ultrasonography with contrast agent SonoVue were significantly higher than that of general ultrasonography (Plt;0.05), while no significant difference in diagnostic specificity and misdiagnosis rate was observed between them (Pgt;0.05). All tumors showed contrast enhancement in various degrees. Of 28 patients with enhanced mass, hyperenhancement in 22 cases and nodular inhomogeneous enhancement in 21 cases were observed and the boundaries of malignant tumor were irregular with ill-defined and radial enhancement. Most of benign tumors were represented by weak, homogeneous enhancement, and the shape was regular with smooth and tidy boundary and intact capsule except seven cases with unclear boundary. These imaging characteristics of benign and malignant tumors were obviously different (P=0.000). In the resolution phase, both benign and malignant mass showed heterogeneous or homogeneous dissipation, which was not significantly different (P=0.791). ConclusionCompared with general ultrasonography, contrast enhanced ultrasonography may be more helpful for the differential diagnosis of benign and malignant breast tumors.
