Gastrointestinal contrast-enhanced ultrasonography for diagnosis and treatment of peptic ulcer in children

BACKGROUND The detection rate of peptic ulcer in children is improving,with development of diagnostic procedures.Gastroscopy is the gold standard for the diagnosis of peptic ulcer,but it is an invasive procedure.Gastrointestinal contrast-enhanced ultrasonography(CEUS)has the advantages of being painless,noninvasive,nonradioactive,easy to use,and safe.AIM To investigate the clinical value of CEUS for diagnosis and treatment of peptic ulcer in children.METHODS We investigated 43 children with digestive tract symptoms in our hospital from January 2021 to June 2022.All children were examined by routine ultrasound,gastrointestinal CEUS,and gastroscopy.The pathological results of gastroscopy were taken as the gold standard.Routine ultrasonography was performed before gastrointestinal CEUS.Conventional ultrasound showed the thickness of the gastroduodenal wall,gastric peristalsis,and the adjacent organs and tissues around the abdominal cavity.Gastrointestinal CEUS recorded the thickness of the gastroduodenal wall;the size,location and shape of the ulcer;gastric peristalsis;and adjacent organs and tissues around the abdominal cavity.The results of routine ultrasound and gastrointestinal ultrasound were compared with those of gastroscopy to evaluate the diagnostic results and coincidence rate of routine ultrasound and gastrointestinal CEUS.All children received informed consent from their guardians for CEUS.This study was reviewed and approved by the hospital medical ethics committee.RESULTS Among the 43 children,17(15 male,2 female)were diagnosed with peptic ulcer by gastroscopy.There were 26 children with nonpeptic ulcer.There were eight cases of peptic ulcer and 35 of nonpeptic ulcer diagnosed by conventional ultrasound.The diagnostic coincidence rate of peptic ulcer in children diagnosed by conventional ultrasound was 79.1%(34/43),which was significantly different from that of gastroscopy(P=0.033).It indicates that the coincidence rate of gastrointestinal contrast-enhanced ultrasound and gastroscope is low.Fifteen cases of peptic ulcer and 28 of nonpeptic ulcer were diagnosed by CEUS.The diagnostic coincidence rate of peptic ulcer in children was 95.3%(41/43).There was no significant difference between CEUS and gastroscopy(P=0.655).It indicates that the coincidence rate of gastrointestinal contrast-enhanced ultrasound and gastroscope is high.CONCLUSION Gastrointestinal CEUS has a high coincidence rate in the diagnosis of peptic ulcer in children,and can be used as a preliminary examination method.

Clinical application of oral contrast-enhanced ultrasound in evaluating the preoperative T staging of gastric cancer

BACKGROUND Oral contrast-enhanced ultrasound(OCEUS)is widely used in the noninvasive diagnosis and screening of gastric cancer(GC)in China.AIM To investigate the clinical application of OCEUS in evaluating the preoperative T staging of gastric cancer.METHODS OCEUS was performed before the operation,and standard ultrasound images were retained.The depth of infiltration of GC(T-stage)was evaluated according to the American Joint Committee on Cancer 8th edition of the tumor-nodemetastasis staging criteria.Finally,with postoperative pathological staging as the gold standard reference,the sensitivity,specificity,negative predictive value,positive predictive value,and diagnostic value of OCEUS T staging were evaluated.RESULTS OCEUS achieved diagnostic accuracy rates of 76.6%(T1a),69.6%(T1b),62.7%(T2),60.8%(T3),88.0%(T4a),and 88.7%(T4b),with an average of 75.5%.Ultrasonic T staging sensitivity exceeded 62%,aside from T1b at 40.3%,while specificity was over 91%,except for T3 with 83.5%.The Youden index was above 60%,with T1b and T2 being exceptions.OCEUS T staging corresponded closely with pathology in T4b(kappa>0.75)and moderately in T1a,T1b,T2,T3,and T4a(kappa 0.40-0.75),registering a concordance rate exceeding 84%.CONCLUSION OCEUS was effective,reliable,and accurate in diagnosing the preoperative T staging of GC.As a noninvasive diagnostic technique,OCEUS merits clinical popularization.

Contrast-enhanced ultrasound using SonoVue mixed with oral gastrointestinal contrast agent to evaluate esophageal hiatal hernia: Report of three cases and a literature review

BACKGROUND Due to a thicker abdominal wall in some patients,ultrasound artifacts from gastrointestinal gas and surrounding tissues can interfere with routine ultrasound examination,precluding its ability to display or clearly show the structure of a hernial sac(HS)and thereby diminishing diagnostic performance for esophageal hiatal hernia(EHH).Contrast-enhanced ultrasound(CEUS)imaging using an oral agent mixture allows for clear and intuitive identification of an EHH sac and dynamic observation of esophageal reflux.CASE SUMMARY In this case series,we report three patients with clinically-suspected EHH,including two females and one male with an average age of 67.3±16.4 years.CEUS was administered with an oral agent mixture(microbubble-based SonoVue and gastrointestinal contrast agent)and identified a direct sign of supradiaphragmatic HS(containing the hyperechoic agent)and indirect signs[e.g.,widening of esophageal hiatus,hyperechoic mixture agent continuously or intermittently reflux flowing back and forth from the stomach into the supradiaphragmatic HS,and esophagus-gastric echo ring(i.e.,the“EG”ring)seen above the diaphragm].All three cases received a definitive diagnosis of EHH by esophageal manometry and gastroscopy.Two lesions resolved upon drug treatment and one required surgery.The recurrence rate in follow-up was 0%.The data from these cases suggest that the new non-invasive examination method may greatly improve the diagnosis of EHH.CONCLUSION CEUS with the oral agent mixture can facilitate clear and intuitive identification of HS and dynamic observation of esophageal reflux.

High-frame-rate contrast-enhanced ultrasound findings of liver metastasis of duodenal gastrointestinal stromal tumor:A case report and literature review

BACKGROUND Liver metastasis of duodenal gastrointestinal stromal tumor(GIST)is rare.Most reports mainly focus on its treatment and approaches to surgical resection,while details on its contrast-enhanced ultrasound(CEUS)findings are lacking.The diagnosis and imaging modalities for this condition remain challenging.CASE SUMMARY A 53-year-old Chinese man presented with mild signs and symptoms of the digestive tract.He underwent routine examinations after GIST surgery.Magnetic resonance imaging showed a 2.3 cm hepatic space-occupying lesion.All the laboratory test results were within normal limits.For further diagnostic confirmation,we conducted high frame rate CEUS(H-CEUS)and found a malignant perfusion pattern.Heterogeneous concentric hyper-enhancement,earlier wash-in than the liver parenchyma,and two irregular vessel columns could be observed at the periphery of the lesion during the arterial phase.Ultrasound-guided puncture biopsy was used to confirm the diagnosis of the lesion as liver metastasis of duodenal GIST.Imatinib was prescribed after biopsy,and the patient’s clinical course was monitored.CONCLUSION H-CEUS is useful for detecting microcirculation differences,wash-in patterns,and vascular morphogenesis and diagnosing liver metastasis of duodenal GIST.

Diagnosis of upper gastrointestinal perforation complicated with fistula formation and subphrenic abscess by contrast-enhanced ultrasound:A case report

BACKGROUND Gastrointestinal perforation complicated by subphrenic abscess is a surgical emergency.Its diagnosis relies mainly on X-ray or computed tomography(CT),while the value of ultrasound,especially contrast-enhanced ultrasound(CEUS),has been underestimated.CASE SUMMARY A 37-year-old man presented with fever and edema of the lower extremities for 10 d.He had a history of laparoscopic repair of gastroduodenal perforation 6 mo prior.His first-time intravenous CEUS indicated a diagnosis of subphrenic abscess.He received antibiotic therapy and ultrasound-guided percutaneous drainage of the abscess.However,second-time intravenous CEUS revealed an unsatisfactory therapeutic effect.Intracavitary CEUS was proposed,and this examination detected communication between the abscess and the stomach.Upper gastrointestinal perforation complicated by fistula formation and subphrenic abscess was diagnosed with the help of CEUS.Abdominal CT and esophagogastroduodenoscopy confirmed the diagnosis.The patient recovered after the perforation was repaired by surgery.CONCLUSION Intravenous and intracavitary CEUS provides helpful information for the diagnosis of upper gastrointestinal perforation complicated by fistula formation and subphrenic abscess.

Contrast-enhanced harmonic endoscopic ultrasound imaging: Basic principles, present situation and future perspectives

Over the last decade, the development of stabilised microbubble contrast agents and improvements in available ultrasonic equipment, such as harmonic imaging, have enabled us to display microbubble enhancements on a greyscale with optimal contrast and spatial resolution. Recent technological advances made contrast harmonic technology available for endoscopic ultrasound(EUS) for the first time in 2008. Thus, the evaluation of microcirculation is now feasible with EUS, prompting the evolution of contrast-enhanced EUS from vascular imaging to images of the perfused tissue. Although the relevant experience is still preliminary, several reports have highlighted contrast-enhanced harmonic EUS(CHEUS) as a promising noninvasive method to visualise and characterise lesions and to differentiate benign from malignant focal lesions. Even if histology remains the gold standard, the combination of CH-EUS and EUS fine needle aspiration(EUS-FNA) can not only render EUS more accurate but may also assist physicians inmaking decisions when EUS-FNA is inconclusive,increasing the yield of EUS-FNA by guiding the puncture with simultaneous imaging of the vascularity.The development of CH-EUS has also opened up exciting possibilities in other research areas,including monitoring responses to anticancer chemotherapy or to ethanolinduced pancreatic tissue ablation,anticancer therapies based on ultrasound-triggered drug and gene delivery,and therapeutic adjuvants by contrast ultrasound-induced apoptosis.Contrast harmonic imaging is gaining popularity because of its efficacy,simplicity and noninvasive nature,and many expectations are currently resting on this technique.If its potential is confirmed in the near future,contrast harmonic imaging will become a standard practice in EUS.

Primary gastrointestinal stromal tumor of the liver: A case report

We report a case of primary gastrointestinal stromal tumor （GIST） of the liver. A 17-year-old man with a solid mass in the anterior segment of the right liver was asymptomatic with negative laboratory examinations with the exception of positive HBV. Contrast-enhanced ultrasound （CEUS） revealed a hypervascular lesion in the arterial phase and hypoechoic features during the portal and late phases. However, enhanced spiral computed tomography （CT） showed hypoattenuation in all three phases. Following biopsy, immunohistochemical evaluation demonstrated positive CDl17. Different imaging features of primary GISTs of the liver are due to pathological properties and different working systems between CEUS and enhanced spiral CT.

口服胃肠超声造影评估不同疾病对胃动力及胃排空功能影响的研究进展

不同疾病可导致胃肠功能紊乱,出现胃肠道症状,进而影响胃动力及胃排空功能,严重影响患者生活质量。因此,评估患者胃动力及胃排空功能对指导临床治疗、疗效评价及判断预后尤为重要。口服胃肠超声造影(OCUS)是近年来新兴的影像学检查手段,在胃动力及胃排空领域的应用逐渐成熟。该文对OCUS评估不同疾病对胃动力及胃排空功能影响的研究进展作一综述。

口服胃肠超声造影检查在胃十二指肠疾病诊断中的应用价值

目的分析胃十二指肠疾病诊断中应用口服胃肠超声造影检查的作用价值。方法随机选取2022年6月—2023年6月临沂老年医院收治的50例疑似胃十二指肠疾病患者为研究对象,将最终病理检查结果视为诊断的金标准,所有患者均接受口服胃肠超声造影检查、肠胃镜检查。对比两种检测方法的检出结果、诊断效能、舒适情况。结果病理检查结果显示,胃溃疡18例、胃炎12例、十二指肠炎10例、胃癌4例、胃息肉6例。口服胃肠超声造影检查符合率(94.00%)低于肠胃镜检查符合率(100.00%),但差异无统计学意义(χ^(2)=3.092,P>0.05)。结论胃十二指肠疾病诊断中口服胃肠超声造影检查精准度略低于肠胃镜检查,但患者舒适评价更高,诊断效能可以满足临床需求。

胃窗超声造影与双重超声造影在胃癌分期及胃间叶源性肿瘤检出的临床价值

目的:探讨胃窗超声造影与双重超声造影用于胃癌分期判断及胃间叶源性肿瘤检出的临床价值。方法:选择42例胃癌患者及31例胃间叶源性肿瘤患者作为研究对象,均进行胃窗超声造影和双重超声造影,比较不同造影方法的诊断价值。结果:胃窗超声造影对T1期、T2期、T3期及T4期胃癌诊断准确率为55.5%、66.7%、66.7%、66.7%。超声双重造影对T1期、T2期、T3期及T4期胃癌诊断准确率分别为77.8%、94.4%、88.9%和83.3%。胃窗超声造影和双重超声造影对胃间叶源性肿瘤的检出率分别为93.5%和74.2%。胃窗超声造影对胃癌病理T分期诊断准确率低于双重超声造影(P<0.05),双重超声造影的敏感性、特异性均高于胃窗超声造影(P<0.05)。结论:双重超声造影对胃癌病理分期的诊断准确率和对胃间质叶源性肿瘤的检出率均较高,可在临床推广应用。

胃腔充盈下超声联合谐波超声造影对胃间质瘤的诊断价值

目的应用胃腔充盈下超声联合谐波超声造影技术观察胃间质瘤,探讨胃间质瘤的超声特征及胃腔充盈下超声联合谐波超声造影技术在胃间质瘤诊断中的应用价值。方法口服胃窗声学造影剂后应用二维超声观察胃间质瘤病变,再以反向脉冲谐波显像技术对二维超声难以定性的病变行谐波超声造影检查,分析胃间质瘤的造影灌注特征。结果本组30例胃间质瘤,其中低危组19例,高危组11例。19例低危组胃间质瘤在谐波超声造影下多表现为肿瘤体积较小(直径<5 cm),形态较规则,多呈圆形或类圆形,内部液化、坏死少见,呈整体较均匀增强;19例高危组胃间质瘤在谐波超声造影下多表现为体积较大(直径>5cm),形态不规则,多呈分叶状,瘤体内部回声不均匀,液化、坏死较多见,呈整体不均匀增强,坏死液化区不增强。结论胃腔充盈下超声联合谐波超声造影技术能够很好的显示胃间质瘤的形态范围,并能结合病变区域微血管灌注情况,对病灶的恶性潜能进行较准确的判断,可为临床治疗提供一定的指导意见。

Diagnosis of bowel diseases:The role of imaging and ultrasonography

Examinations with a visualisation of the anatomy and pathology of the gastrointestinal(GI) tract are often necessary for the diagnosis of GI diseases.Traditional radiology played a crucial role for many years.Endoscopy,despite some limitations,remains the main technique in the differential diagnosis and treatment of GI diseases.In the last decades,the introduction of,and advances in,non-invasive cross-sectional imaging modalities,including ultrasound(US),computed tomography(CT),positron-emission tomography(PET),and magnetic resonance imaging,as well as improvements in the resolution of imaging data,the acquisition of 3D images,and the introduction of contrast-enhancement,have modified the approach to the examination of the GI tract.Moreover,additional co-registration techniques,such as PET-CT and PET-MRI,allow multimodal data acquisition with better sensitivity and specificity in the study of tissue pathology.US has had a growing role in the development and application of the techniques for diagnosis and management of GI diseases because it is inexpensive,non-invasive,and more comfortable for the patient,and it has sufficient diagnostic accuracy toprovide the clinician with image data of high temporal and spatial resolution.Moreover,Doppler and contrastenhanced ultrasound(CEUS) add important information about blood flow.This article provides a general review of the current literature regarding imaging modalities used for the evaluation of bowel diseases,highlighting the role of US and recent developments in CEUS.

口服胃肠超声检查联合血清肿瘤标记物对中老年胃癌的诊断价值

目的探讨并分析口服胃肠超声联合血清肿瘤标记物在中老年胃癌患者中的诊断价值。方法选取我院2018年9月~2019年12月97例疑似中老年胃癌患者作为研究对象,所有患者均进行口服胃肠超声和血清CEA、CA72-4、CA19-9检测,以最终的病理结果作为对照,比较所有患者超声检测结果分析其超声特征,并分析超声及血清CEA、CA72-4、CA19-9联合诊断的灵敏度、特异度、准确性。结果97例疑似患者中经病理证实86例为胃癌患者,以病理结果为金标准,口服超声、血清CEA、CA72-4、CA19-9、超声联合血清检出胃癌例数分别为72、53、56、61、81例,对应检出率分别为83.72%、61.63%、65.11%、70.93%、94.19%;口服超声、血清CEA、血清CA72-4、血清CA19-9单一诊断结果与病理检查结果比较,差异均有统计学意义(P<0.05);口服超声、血清CEA、血清CA72-4、血清CA19-9联合诊断结果与病理检查结果比较,差异无统计学意义(P>0.05);联合检测诊断胃癌灵敏度、特异度、准确度分别为94.19%(81/86)、90.91%(10/11)、93.81%(91/97),其灵敏度与准确度明显高于口服超声、CEA、CA72-4、CA19-9单一诊断(P<0.05)。结论口服胃肠超声联合血清肿瘤标记物在诊断老年人胃癌方面要比单一使用超声诊断率更高,对临床诊断具有积极作用。

口服胃肠超声造影评价慢性肾病患者胃动力和胃壁形态改变的研究

目的采用口服胃肠超声造影对慢性肾病(CKD)患者胃动力和胃壁形态改变进行评价和研究。方法选取2019年3月—2023年3月河北省第七人民医院收治的105例CKD患者作为研究组,选取同期82例志愿者作为对照组,对二组研究对象的基线资料进行比较,采用口服胃肠超声造影对二组研究对象的胃排空率(GER)、胃排空时间(ET)、服用造影剂10min时胃窦动力指数(MI)、胃窦胃壁厚度和十二指肠胃窦反流(DGR)、胃壁层次清晰度进行检测和比较。结果研究组患者合并高血压、糖尿病比例和ET、胃窦胃壁厚度、DGR比例、胃壁层次模糊比例均高于对照组,GER、MI均低于对照组,差异均有统计学意义(P<0.05);随着CKD分期的升高,患者的GER、MI逐渐下降,ET、胃窦胃壁厚度、DGR比例、胃壁层次模糊比例逐渐升高,差异均有统计学意义(P<0.05)。研究组患者的GER、MI水平与CKD分期呈负相关关系(P<0.05),ET、胃窦胃壁厚度与CKD分期呈正相关关系(P<0.05)。结论CKD患者表现为胃动力和胃壁层次清晰度的下降,其病变程度与CKD分期具有相关性,采用口服胃肠超声造影检查能够对于CKD患者的胃肠功能进行定量评价,具有无创安全、费用低廉、可耐受度高的优势。