摘要:目的:探討床旁超聲檢查在肝移植術后下腔靜脈(IVC)并發癥診斷中的應用價值。方法:對424例肝移植術后患者進行床旁超聲檢查,對下腔靜脈并發癥,包括狹窄及栓塞的資料進行回顧性分析和總結。結果:床旁超聲檢查發現下腔靜脈并發癥患者18例,其中狹窄6例,栓塞12例。結論:床旁超聲檢查在肝移植術后,尤其是對術后早期發生的下腔靜脈并發癥的診斷及監測具有重要的作用,為臨床診斷和治療提供及時、有價值的影像學依據。Abstract: Objective: To evaluate the value of bedside ultrasound in diagnosis and monitoring of inferior vena cava (IVC) complications after liver transplantation. Methods: 424 cases with liver transplantation were examined by bedside ultrasound after the operations. The results of IVC complications,including thrombosis and stenosis, were analyzed and summarized. Results: 18 cases with IVC complications were detected by bedside ultrasound, including 6 cases of stenosis and 12 cases of thrombosis. Conclusion: Bedside ultrasound is important for diagnosing and monitoring IVC thrombosis and stenosis after liver transplantation, especially in the earlier period. It could provide valuable imaging for clinical diagnosis and treatment promptly.
Intravascular ultrasound (IVUS) is widely used in coronary artery examination. Ultrasonic elastography combined with IVUS is very conspicuous in identifying plaque component and in detecting plaque vulnerability degree. In this study, a simulation model of the blood vessel based on finite element analysis (FEA) was established. The vessel walls generally have radial changes caused by different intravascular pressure. The signals at lower pressures were used as the pre-deformation data and the signals at higher pressure were used as the post-deformation data. Displacement distribution was constructed using the time-domain cross-correlation method, and then strain images. By comparison of elastograms under different pressures, we obtained the optimal pressure step. Furthermore, on the basis of the obtained optimize pressure step, the simulation results showed that this method could effectively distinguish characteristics between different component plaques, and could guide the later experiments and clinical applications.
ObjectivesTo systematically review the safety and effectiveness of uterine artery embolization (UAE), surgery and high intensity focused ultrasound (HIFU) in the treatment of uterine fibroids.MethodsPubMed, EMbase, The Cochrane Library, Web of Science, WanFang Data and CNKI databases were electronically searched to collect relevant studies on comparing the safety and effectiveness of UAE, surgery and HIFU in the treatment of uterine fibroids from January 2000 to August 2019. Two reviewers independently screened the literature, extracted the data and evaluated the risk of bias of included studies, network meta-analysis was performed by ADDIS 1.16.8 software and Stata 14.0 software.ResultsA total of 11 trials (22 references) involving 3469 patients were included. Compared with surgery, UAE and HIFU patients had higher quality of life (1-year follow-up) improvement, and UAE was higher than HIFU. Network meta-analysis showed that patients treated with HIFU had the lowest incidence of major complications within 1 year, followed by UAE, and surgery. Patients treated with HIFU and UAE had shorter hospitalization and quicker recovery time than surgery. The rate of further intervention after surgery treatment might be lower than that of UAE and HIFU.ConclusionsUAE has the highest quality of life improvement (1-year follow-up) for uterine fibroids. HIFU and UAE are safer with shorter hospital stays and quicker recovery time compared with surgery. However, both UAE and HIFU have the risk of re-treatment. However, limited by the number and quality of included studies, the above conclusions are needed to be verified by more high-quality studies.
Objective To explore the clinical value of shear wave elastography in the evaluation of quadriceps femoris lesions in patients with chronic obstructive pulmonary disease (COPD). Methods Fifty-eight COPD patients who were admitted to Chengdu First People’s Hospital and 55 healthy controls were included in the study between August 2021 and February 2022. The thickness, circumference, cross-sectional area and Young's modulus of quadriceps femoris in all subjects were measured using shear wave elastography combined with conventional two-dimensional ultrasound. The differences in ultrasound parameters between the two groups were compared, and the correlation between each ultrasound parameter and clinical evaluation indicators (modified British Medical Research Council Scale, COPD Assessment Test, six-minute walk test, and five-time sit-to-stand test) was analyzed. Results Young’s modulus values of the quadriceps femoris muscle were smaller in the COPD group than those in the healthy control group [COPD Group: rectus femoris 6.72 (6.22, 7.36) kPa, vastus medialis 6.25 (5.82, 6.79) kPa, vastus lateralis 6.94 (6.17, 7.48) kPa; healthy control group: rectus femoris 11.40 (10.23, 12.11) kPa, vastus medialis 10.77 (9.62, 11.42) kPa, vastus lateralis 11.14 (10.42, 12.52) kPa]. The differences were statistically significant (all P<0.05). The Young's modulus value of the rectus femoris muscle correlates with the aforementioned clinical evaluation indicators, with positive correlation with six-minute walk distance and negative correlation with COPD Assessment Test, modified British Medical Research Council Scale, five-time sit-to-stand time (P<0.05). Quadriceps thickness, circumference, and cross-sectional area measured by conventional two-dimensional ultrasound were not significantly different between the two groups, nor were there significant correlations between each parameter and clinical parameters (P>0.05). In addition, shear wave elastography has good reproducibility in the measurement of Young's modulus in quadriceps. Conclusions Shear wave elastography can identify quadriceps lesions earlier than conventional two-dimensional ultrasound in COPD patients, and there is a significant correlation between its measurements and the clinical condition of COPD patients. Shear wave elastography may provide a simple and noninvasive method for clinical evaluation of quadriceps femoris lesions in COPD patients.
In recent years, with the development of ultrasound technology, pulmonary ultrasound is more and more used in the evaluation of patients with heart failure. B-lines are defined as reverberation artifacts starting from the pleural line and extending to the bottom of the screen without disappearing, and moving synchronously with pleural sliding, which are proportional to extravascular lung water in congestive heart failure (CHF). B-lines have the characteristics of no attenuation and synchronous movement with pleural sliding. Pulmonary ultrasound mainly record the numbers and widths of B-lines in the areas when assessing the severity of CHF, which have the characteristics of effectivity, non-invasiveness, instantaneousness, and good repeatability. Currently, there are 4-, 8-, 12-, and 28-subdivision methods for the evaluation of CHF in the pulmonary ultrasound subdivision method. The more subdivisions are, the longer the operation time will be, and the sensitivity and specificity will be different. How to choose a subdivision method is still controversial in clinical practice. Lung ultrasound could be used alone or combined with brain natriuretic peptide, echocardiography, chest X-ray, chest CT scan, etc. in the early diagnosis, assessment of disease severity, evaluation of efficacy, and assessment of prognosis of CHF, with different advantages and disadvantages. This article reviews the application and progress of pulmonary ultrasound in CHF.
ObjectiveTo construct a cationic microbubble (CMB), and investigate the enhancement of gene transfection efficiency and therapeutic effect of ultrasound-targeted microbubble destruction (UTMD) in vivo with CMB compared to definity MB (DMB).Methods In vitro, the CMB was prepared by the method of thin film hydration. The morphology, size, zeta potential, and gene-carrying capacity of CMB were compared with the DMB. In vivo, the firefly luciferase gene which was used as a reporter gene was targeted transfected into myocardium of 16 rats with CMB and DMB, respectively. The gene transfection efficiency and targeting were observed dynamically. Then, ischemia-reperfusion (I/R) model was performed on 64 rats. The models of 60 rats were successfully confirmed by using ultrasonography at 5 days after I/R. The rats were divided into 3 groups (n=20) randomly. The control group received DMB carrying empty plasmid for transfection; DMB group received DMB carrying AKT plasmid for transfection; and CMB group received CMB carrying AKT plasmid for transfection. The cardiac perfusion, cardiac function, infarct size, and infarct thickness were measured by ultrasonography and histological observations after treatment. In addition, the capillary and arteriolar densities were measured with immunohistochemical staining. The myocyte apoptosis was measured with TUNEL staining. The protein expressions of AKT, phospho-AKT (P-AKT), Survivin, and phospho-BAD (P-BAD) were measured by Western blot.ResultsThe size of CMB was uniformly. The zeta potential of CMB was significantly higher than that of DMB (t=28.680, P=0.000). The CMB bound more plasmid DNA than the DMB (P<0.05). The luciferase activity of myocardium were higher in CMB group than in DMB group bothin vitro and in vivo measurements (P<0.05). There was no significant difference between groups in the ratio of signal intensity in anterior wall to posterior wall, ejection fraction (EF), and fractional shortening (FS) at 5 days after I/R (P>0.05), but the above indexes were significant higher in CMB and DMB groups than in control group at 21 days after I/R (P<0.05). Besides, the above indexes were significant higher in CMB group than in DMB group at 21 days after I/R (P<0.05). The infarct size was the smallest and infarct thickness was the thickest in the CMB group, followed by DMB group, control group at 21 days after I/R. The capillary and arteriolar densities of CMB and DMB groups were significant higher than those of control group at 21 days after I/R (P<0.05). Besides, the capillary and arteriolar densities of CMB group were significant higher than those of DMB group (P<0.05). The apoptotic cells were the most in the control group, followed by DMB group, CMB group at 3 days after gene transfection, showing significant differences between groups (P<0.05). The protein expressions of AKT, P-AKT, Survivin, and P-BAD were significant higher in CMB and DMB groups than those in control group at 3 days after gene transfection (P<0.05). Besides, these protein expressions were significant higher in CMB group than those in DMB group (P<0.05).ConclusionThe DNA-carrying capacity and gene transfection efficiency are elevated by CMB, although its physicochemical property is the same as DMB. When ultrasound-targeted AKT gene transfection is used to treat myocardial I/R injury in rats, delivery of AKT with the CMB can result in higher transfection efficiency and greater cardiac functional improvements compared to the DMB.
ObjectiveTo investigate the feasibility and effectiveness of using ultrasound to evaluate the internal mammary artery (IMA) and explore the related factors affecting the quality of IMA.MethodsFrom July 2020 to January 2021, for patients who underwent coronary artery bypass grafting at the Department of Cardiovascular Surgery, Fuwai Hospital, ultrasound was applied to measure bilateral IMA at the parasternal second intercostal space. There were 62 males and 18 females with an average age of 59.9±8.3 years. The clinical data of the patients were recorded and analyzed.ResultsA total of 160 IMA were measured. The IMA was detected in 99.4% (159/160), and the one that was not measured was proved to be occluded by enhanced CT. A total of 157 (98.1%) IMA intima were smooth, 2 (1.3%) were found to have uneven intimal thickening and less smooth, and only 1 (0.6%) was occluded. The intravascular diameter, peak systolic flow rate, peak diastolic flow rate, and blood flow rate of the left second intercostal IMA were 1.9±0.3 mm, 66.8±17.7 cm/s, 6.4 (0.0, 9.7) cm/s, 19.7±9.4 mL/min; and those of the right one were 2.1±0.3 mm, 69.7±18.5 cm/s, 6.0 (0.0, 9.2) cm/s and 22.8±11.5 mL/min, respectively. IMA vessel diameter and blood flow were greater on the right than those on the left side in the same individual (P<0.01). In univariate analysis, sex and body surface area were the factors that influenced the size of the IMA vessel among different individuals, and by linear regression analysis, the size of the IMA vessel was only related to body surface area among different individuals. On univariate analysis, diabetes mellitus was the only factor affecting IMA blood flow, with a mean reduction in blood flow of 18.4% (left) and 21.7% (right) in the diabetic group (P<0.05).ConclusionPreoperative evaluation of the IMA using ultrasound over the parasternal second intercostal space is easy, noninvasive, and has a high success rate. The internal diameter of the IMA is positively correlated with body surface area, and blood flow is significantly reduced in patients with diabetes.
ObjectiveTo evaluate the clinical value of color Doppler ultrasound in diagnosing prehepatic portal hypertension.
MethodsA retrospective analysis was performed to analyze the results of color Doppler ultrasonography in 9 patients with prehepatic portal hypertension diagnosed between June 2012 and January 2015, including vessel diameter, shape, nature and direction of blood flow, and fistula blood flow spectrum.
ResultsAmong the 9 patients, the color Doppler ultrasound found 3 patients with regional portal widened, increased and faster blood flow with the emergence of low-impedance spectrum artery, splenic vein widened with returning blocked and flocculent substance within the splenic vein lumen, irregular or streak-shaped low weak echo during splenic vein reduction, and unstable or weakened blood flow velocity. Two patients were confirmed with splenic vein thrombosis by ultrasound and other imaging methods with significantly reduced blood in splenic vein. For the other four patients with regional portal hypertension, obvious abnormalities in portal system were not detected by color Doppler ultrasound, but they were checked with other methods. The ultrasound positive diagnosis of the 9 patients was 5, with 4 missed.
ConclusionThe color Doppler ultrasound has some values in screening, diagnosis and follow-up of prehepatic portal hypertension, but it can also be influenced by many factors with a high missed diagnosis rate. Carefully observing the portal system lumen structure, internal echo and blood flow combined with other imaging studies, and emphasizing clinical history of the patients can further improve diagnostic accuracy.
摘要:目的:評價膝關節滑膜超聲檢查在類風濕關節炎(RA)患者隨訪中的價值及其與RA臨床活動度之間的相關性。方法:收集確診的RA病人40例,其中68個膝關節有陽性癥狀。分別收集40例RA患者的臨床資料,計算其疾病活動度DSA28,同時行膝關節超聲檢查,對有陽性癥狀的膝關節動態隨訪三次上述指標,每月一次。結果:每月RA患者的DSA28分值與受檢膝關節髕上囊內液體深度、滑膜內血流信號等級呈正相關(Plt;0.05);膝關節髕上囊內液體深度、滑膜內血流信號等級以及滑膜厚度三者之間均呈正相關(Plt;0.05)。結論:膝關節滑膜內血流信號等級和膝關節髕上囊內液體深度是良好的隨訪RA患者療效與評估RA患者活動度的超聲指標。Abstract: Objective: To evaluation the disease of synovial in knee joints in patients with RA by ultrasound, and investigate the relationship between the clinic activity of RA and findings by ultrasound. Methods: The clinic dates and ultrasound of 40 RA patients, including 68 knee joints have positive symptom were collected by every month. The course of treatment was 3 months. Results: The score of DSA28 was correlated with the thick of effusion in bursa supragenual and the blood single of synovial in knee joints(Plt;0.05);the correlation also found among the thick of effusion in bursa supragenual.the thick of synovial and the blood singal of synovial in knee joints (Plt;0.05). Conclusion: The thick of effusion in bursa supragenual and the blood single of synovial in knee joints was excellent ultrasound index in RA.
Objective To determine the role of multi-slice spiral computed tomography (MSCT) compared with transrectal ultrasound (TRUS) in preoperative staging of rectal cancer. Methods Patients with rectal cancer from January to May 2009 in Department of Anal-Colorectal Surgery of West China Hospital were enrolled. All patients were preoperatively examined by both MSCT and TRUS for T and N staging, which were compared with postoperative pathological findings. Results The study population consisted of 81 patients. Regarding depth of tumor invasion, the accuracy of TRUS (88.89%) was not significantly higher than that of MSCT (77.78%), P=0.168. Regarding lymph node metastasis, the result of MSCT was more accurate than that of TRUS (66.67% vs. 48.15%, P=0.034). Conclusions Although TRUS remains the advantages in evaluating local invasion, the gap between MSCT and TRUS are significantly diminished. MSCT is superior to TRUS in evaluation of lymph node metastasis, however, further improvement on the diagnostic accuracies would be warranted in both modalities.
