Contrast-Enhanced CT-Guided Core Biopsy of Retroperitoneal Masses

Objective: To evaluate the efficacy, feasibility and safety of contrast-enhanced CT-guided core biopsy of retroperitoneal masses. Materials and Methods: Contrast-enhanced CT-guided biopsy of retroperitoneal masses was performed in 26 patients. Histopathological diagnosis was obtained and accuracy was calculated. Two blinded radiologists determined feasibility of biopsy procedures on routine CT-guidance, and compared accessibility of target lesions using contrast-enhanced and non-contrast-enhanced CT. Results: Satisfactory samples were obtained in all 26 patients and pathological diagnosis was made in 24. Accuracy was 95.5%. Routine CT-guided biopsy punctures were not satisfaction in 4/26 patients, and contrast-enhanced CT scans rendered the target lesions more accessible in 16 patients. Conclusion: Contrast-enhanced CT-guided biopsy increases the feasibility of biopsy of retroperitoneal masses.

Correlation of contrast-enhanced CT quantitative parameters with proliferation and invasion gene expression in pancreatic cancer

Objective: To discuss the correlation of contrast-enhanced CT quantitative parameters with proliferation and invasion gene expression in pancreatic cancer. Methods: A total of 100 patients with pancreatic cancer who were treated in the hospital between May 2015 and May 2017 were selected as pancreatic cancer group, and 48 patients with necrotic pancreatitis who received surgical treatment in the hospital during the same period were selected as pancreatitis group. Differences in pancreatic contrast-enhanced CT value as well as the expression of proliferation-related genes and invasion-related genes in lesion tissue were compared between the two groups, and Pearson test was used to evaluate the correlation of pancreatic cancer tissue CT value with proliferation and invasion gene expression. Results: Contrast-enhanced CT value of pancreatic cancer tissue was lower than that of pancreatitis tissue;proliferation-related genes Bmi-1, Ezrin and FOXC1 mRNA expression in lesion tissue of pancreatic cancer group were higher than those of pancreatitis group while EphB2 and RGC-32 mRNA expression were lower than those of pancreatitis group;invasion-related genes FHL1, JDP2, Let-7f and TFPI-2 mRNA expression in lesion tissue of pancreatic cancer group were lower than those of pancreatitis group while Twist and HOXB7 mRNA expression were higher than those of pancreatitis group. Pearson test showed that the contrast-enhanced CT value of pancreatic cancer was directly correlated with the proliferation and invasion gene expression in lesion tissue. Conclusion: Contrast-enhanced CT value of pancreatic cancer tissue was lower than that of normal pancreas tissue, and the specific CT value was directly correlated with the tumor proliferation and invasion-related gene expression, and can be used as a simple and reliable method for early diagnosis of disease and judgement of illness severity.

Contrast-Enhanced CT Colonography Features of Rectal Carcinoid Tumors

Purpose: The purpose of this study was to retrospectively assess the detectability and enhancement pattern of rectal carcinoid tumors on contrast-enhanced computed tomography colonography (CE-CTC). Methods: The study sample consisted of 12 lesions in nine patients of rectal carcinoid tumors. To evaluate the detectability, two radiologists reviewed axial and 3D images including air enema (AE), virtual endoscopy (VE), and virtual colon dissection (VCD). To determine the contrast enhancement pattern of the tumors, the CT attenuation value of each lesion was measured in three phases. Results: Four of the 12 lesions (33%) were detected on axial images in patients in both the prone and supine positions, the sizes of which were 6 mm or larger. Seven lesions (58%), including the four lesions mentioned above, were detected on 3D images including AE and VE in patients in the prone position, the sizes of which were 5 mm or larger. The ranges of CT attenuation values of the lesions at 40 s, 70 s and 240 s were 112 - 147, 116 - 140 and 82 - 97 HU, respectively. Conclusion: Rectal carcinoid tumors are challenging to detect on CE-CTC. They demonstrated enhancement at the early phase and washout at the delayed phase on CE-CTC.

Double contrast-enhanced ultrasonography improves diagnostic accuracy of T staging compared with multi-detector computed tomography in gastric cancer patients

BACKGROUND Gastric cancer(GC)is the most common malignant tumor and ranks third for cancer-related deaths among the worldwide.The disease poses a serious public health problem in China,ranking fifth for incidence and third for mortality.Knowledge of the invasive depth of the tumor is vital to treatment decisions.AIM To evaluate the diagnostic performance of double contrast-enhanced ultrasonography(DCEUS)for preoperative T staging in patients with GC by comparing with multi-detector computed tomography(MDCT).METHODS This single prospective study enrolled patients with GC confirmed by preoperative gastroscopy from July 2021 to March 2023.Patients underwent DCEUS,including ultrasonography(US)and intravenous contrast-enhanced ultrasonography(CEUS),and MDCT examinations for the assessment of preoperative T staging.Features of GC were identified on DCEUS and criteria developed to evaluate T staging according to the 8th edition of AJCC cancer staging manual.The diagnostic performance of DCEUS was evaluated by comparing it with that of MDCT and surgical-pathological findings were considered as the gold standard.RESULTS A total of 229 patients with GC(80 T1,33 T2,59 T3 and 57 T4)were included.Overall accuracies were 86.9%for DCEUS and 61.1%for MDCT(P<0.001).DCEUS was superior to MDCT for T1(92.5%vs 70.0%,P<0.001),T2(72.7%vs 51.5%,P=0.041),T3(86.4%vs 45.8%,P<0.001)and T4(87.7%vs 70.2%,P=0.022)staging of GC.CONCLUSION DCEUS improved the diagnostic accuracy of preoperative T staging in patients with GC compared with MDCT,and constitutes a promising imaging modality for preoperative evaluation of GC to aid individualized treatment decision-making.

Evaluating the efficacy of percutaneous puncture biopsy guided by contrast-enhanced ultrasound for peripheral pulmonary lesions

BACKGROUND The incidence and mortality of lung cancer have increased annually.Accurate diagnosis can help improve therapeutic efficacy of interventions and prognosis.Percutaneous lung biopsy is a reliable method for the clinical diagnosis of lung cancer.Ultrasound-guided percutaneous lung biopsy technology has been widely promoted and applied in recent years.AIM To investigate the diagnostic value of contrast-enhanced ultrasound(CEUS)-guided percutaneous biopsy in peripheral pulmonary lesions.METHODS We retrospectively collected data on 237 patients with peripheral thoracic focal lesions who underwent puncture biopsy at Wuxi People’s Hospital.The patients were randomly divided into two groups:The CEUS-guided before lesion puncture group(contrast group)and conventional ultrasound-guided group(control group).Analyze the diagnostic efficacy of the puncture biopsy,impact of tumor size,and number of puncture needles and complications were analyzed and compared between the two groups.RESULTS Accurate pathological results were obtained for 92.83%(220/237)of peripheral lung lesions during the first biopsy,with an accuracy rate of 95.8%(113/118)in the contrast group and 89.9%(107/119)in the control group.The difference in the area under the curve(AUC)between the contrast and the control groups was not statistically significant(0.952 vs 0.902,respectively;P>0.05).However,when the lesion diameter≥5 cm,the diagnostic AUC of the contrast group was higher than that of the control group(0.952 vs 0.902,respectively;P<0.05).In addition,the average number of puncture needles in the contrast group was lower than that in the control group(2.58±0.53 vs 2.90±0.56,respectively;P<0.05).CONCLUSION CEUS guidance can enhance the efficiency of puncture biopsy of peripheral pulmonary lesions,especially for lesions with a diameter≥5 cm.Therefore,CEUS guidance has high clinical diagnostic value in puncture biopsy of peripheral focal lung lesions.

Contrast-enhanced guided endoscopic ultrasound procedures

Contrast-enhanced endoscopic ultrasound(CH-EUS)can overcome the limi-tations of endoscopic ultrasound-guided acquisition by identifying microvessels inside inhomogeneous tumours and improving the characterization of these tumours.Despite the initial enthusiasm that oriented needle sampling under CH-EUS guidance could provide better diagnostic yield in pancreatic solid lesions,further studies did not confirm the supplementary values in cases of tissue acquisition guided by CH-EUS.This review details the knowledge based on the available data on contrast-guided procedures.The indications for CH-EUS tissue acquisition include isoechoic EUS lesions with poor visible delineation where CH-EUS can differentiate the lesion vascularisation from the surrounding parenchyma and also the mural nodules within biliopancreatic cystic lesions,which occur in select cases.Additionally,the roles of CH-EUS-guided therapy in patients whose pancreatic fluid collections or bile ducts that have an echogenic content have indications for drainage,and patients who have nonvisualized vessels that need to be highlighted via Doppler EUS are presented.Another indication is represented if there is a need for an immediate assessment of the post-radiofrequency ablation of pancreatic neuroendocrine tumours,in which case CH-EUS can be used to reveal the incomplete tumour destruction.

Survival Analysis of Patients Undergoing Intraoperative Contrast-enhanced Ultrasound in the Surgical Treatment of Malignant Glioma

Objective:Complete resection of malignant gliomas is often challenging.Our previous study indicated that intraoperative contrast-enhanced ultrasound(ICEUS)could aid in the detection of residual tumor remnants and the total removal of brain lesions.This study aimed to investigate the survival rates of patients undergoing resection with or without the use of ICEUS and to assess the impact of ICEUS on the prognosis of patients with malignant glioma.Methods:A total of 64 patients diagnosed with malignant glioma(WHO grade HI and IV)who underwent surgery between 2012 and 2018 were included.Among them,29 patients received ICEUS.The effects of ICEUS on overall survival(OS)and progression-free survival(PFS)of patients were evaluated.A quantitative analysis was performed to compare ICEUS parameters between gliomas and the surrounding tissues.Results:The ICEUS group showed better survival rates both in OS and PFS than the control group.The univariate analysis revealed that age,pathology and ICEUS were significant prognostic factors for PFS,with only age being a significant prognostic factor for OS.In multivariate analysis,age and ICEUS were significant prognostic factors for both OS and PFS.The quantitative analysis showed that the intensity and transit time of microbubbles reaching the tumors were significantly different from those of microbubbles reaching the surrounding tissue.Conclusion:ICEUS facilitates the identification of residual tumors.Age and ICEUS are prognostic factors for malignant glioma surgery,and use of ICEUS offers a better prognosis for patients with malignant glioma.

Detection and classification of breast lesions using multiple information on contrast-enhanced mammography by a multiprocess deep-learning system: A multicenter study

Objective: Accurate detection and classification of breast lesions in early stage is crucial to timely formulate effective treatments for patients. We aim to develop a fully automatic system to detect and classify breast lesions using multiple contrast-enhanced mammography(CEM) images.Methods: In this study, a total of 1,903 females who underwent CEM examination from three hospitals were enrolled as the training set, internal testing set, pooled external testing set and prospective testing set. Here we developed a CEM-based multiprocess detection and classification system(MDCS) to perform the task of detection and classification of breast lesions. In this system, we introduced an innovative auxiliary feature fusion(AFF)algorithm that could intelligently incorporates multiple types of information from CEM images. The average freeresponse receiver operating characteristic score(AFROC-Score) was presented to validate system’s detection performance, and the performance of classification was evaluated by area under the receiver operating characteristic curve(AUC). Furthermore, we assessed the diagnostic value of MDCS through visual analysis of disputed cases,comparing its performance and efficiency with that of radiologists and exploring whether it could augment radiologists’ performance.Results: On the pooled external and prospective testing sets, MDCS always maintained a high standalone performance, with AFROC-Scores of 0.953 and 0.963 for detection task, and AUCs for classification were 0.909[95% confidence interval(95% CI): 0.822-0.996] and 0.912(95% CI: 0.840-0.985), respectively. It also achieved higher sensitivity than all senior radiologists and higher specificity than all junior radiologists on pooled external and prospective testing sets. Moreover, MDCS performed superior diagnostic efficiency with an average reading time of 5 seconds, compared to the radiologists’ average reading time of 3.2 min. The average performance of all radiologists was also improved to varying degrees with MDCS assistance.Conclusions: MDCS demonstrated excellent performance in the detection and classification of breast lesions,and greatly enhanced the overall performance of radiologists.

Radiomics model based on contrast-enhanced computed tomography to predict early recurrence in patients with hepatocellular carcinoma after radical resection

BACKGROUND Radical resection remains an effective strategy for patients with hepatocellular carcinoma(HCC).Unfortunately,the postoperative early recurrence(recurrence within 2 years)rate is still high.AIM To develop a radiomics model based on preoperative contrast-enhanced computed tomography(CECT)to evaluate early recurrence in HCC patients with a single tumour.METHODS We enrolled a total of 402 HCC patients from two centres who were diagnosed with a single tumour and underwent radical resection.First,the features from the portal venous and arterial phases of CECT were extracted based on the region of interest,and the early recurrence-related radiomics features were selected via the least absolute shrinkage and selection operator proportional hazards model(LASSO Cox)to determine radiomics scores for each patient.Then,the clinicopathologic data were combined to develop a model to predict early recurrence by Cox regression.Finally,we evaluated the prediction performance of this model by multiple methods.RESULTS A total of 1915 radiomics features were extracted from CECT images,and 31 of them were used to determine the radiomics scores,which showed a significant difference between the early recurrence and nonearly recurrence groups.Univariate and multivariate Cox regression analyses showed that radiomics scores and serum alphafetoprotein were independent indicators,and they were used to develop a combined model to predict early recurrence.The area under the receiver operating characteristic curve values for the training and validation cohorts were 0.77 and 0.74,respectively,while the C-indices were 0.712 and 0.674,respectively.The calibration curves and decision curve analysis showed satisfactory accuracy and clinical utilities.Kaplan-Meier curves based on recurrence-free survival and overall survival showed significant differences.CONCLUSION The preoperative radiomics model was shown to be effective for predicting early recurrence among HCC patients with a single tumour.

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 value of oral contrast-enhanced ultrasonography in diagnosis of gastric tumors

BACKGROUND The incidence of gastric cancer remains high,and it is the sixth most common cancer and the fourth leading cause of cancer deaths worldwide.Oral contrastenhanced ultrasonography is a simple,non-invasive,and painless method for the diagnosis of gastric tumors.AIM To explore the diagnostic value of oral contrast-enhanced ultrasonography for the detection of gastric tumors.METHODS The screening results based on oral contrast-enhanced ultrasonography and electronic gastroscopy were compared with those of the postoperative pathological examination.RESULTS Among 42 patients with gastric tumors enrolled in the study,the diagnostic accordance rate was 95.2%for oral contrast-enhanced ultrasonography(n=40)and 90.5%for electronic gastroscopy(n=38)compared with postoperative pathological examination.The Kappa value of consistency test with pathological findings was 0.812 for oral contrast-enhanced ultrasonography and 0.718 for electronic gastroscopy,and there was no significant difference between them(P=0.397).For the TNM staging of gastric tumors,the accuracy rate of oral contrast enhanced ultrasonography was 81.9%for the overall T staging and 50%,77.8%,100%,and 100%for T1,T2,T3,and T4 staging,respectively.The sensitivity and specificity were both 100%for stages T3 and T4.The diagnostic accuracy rate of oral contrast-enhanced ultrasonography was 93.8%,80%,100%,and 100%for stages N0,N1-N3,M0,and M1,respectively.CONCLUSION The accordance rate of qualitative diagnosis by oral contrast-enhanced ultrasonography is comparable to that of gastroscopy,and it could be used as the preferred method for the early screening of gastric tumors.

Ultrasomics in liver cancer: Developing a radiomics model for differentiating intrahepatic cholangiocarcinoma from hepatocellular carcinoma using contrast-enhanced ultrasound

BACKGROUND Hepatocellular carcinoma(HCC)and intrahepatic cholangiocarcinoma(ICC)represent the predominant histological types of primary liver cancer,comprising over 99%of cases.Given their differing biological behaviors,prognoses,and treatment strategies,accurately differentiating between HCC and ICC is crucial for effective clinical management.Radiomics,an emerging image processing technology,can automatically extract various quantitative image features that may elude the human eye.Reports on the application of ultrasound(US)-based radiomics methods in distinguishing HCC from ICC are limited.METHODS In our retrospective study,we included a total of 280 patients who were diagnosed with ICC(n=140)and HCC(n=140)between 1999 and 2019.These patients were divided into training(n=224)and testing(n=56)groups for analysis.US images and relevant clinical characteristics were collected.We utilized the XGBoost method to extract and select radiomics features and further employed a random forest algorithm to establish ultrasomics models.We compared the diagnostic performances of these ultrasomics models with that of radiologists.RESULTS Four distinct ultrasomics models were constructed,with the number of selected features varying between models:13 features for the US model;15 for the contrast-enhanced ultrasound(CEUS)model;13 for the combined US+CEUS model;and 21 for the US+CEUS+clinical data model.The US+CEUS+clinical data model yielded the highest area under the receiver operating characteristic curve(AUC)among all models,achieving an AUC of 0.973 in the validation cohort and 0.971 in the test cohort.This performance exceeded even the most experienced radiologist(AUC=0.964).The AUC for the US+CEUS model(training cohort AUC=0.964,test cohort AUC=0.955)was significantly higher than that of the US model alone(training cohort AUC=0.822,test cohort AUC=0.816).This finding underscored the significant benefit of incorporating CEUS information in accurately distin-guishing ICC from HCC.CONCLUSION We developed a radiomics diagnostic model based on CEUS images capable of quickly distinguishing HCC from ICC,which outperformed experienced radiologists.

Ultrasound,contrast-enhanced ultrasound and pyelonephritis:A narrative review

Acute pyelonephritis(APN)is a bacterial infection resulting in kidney inflammation,typically arising as a complication of an ascending urinary tract infection that ascends from the bladder to the kidneys.Clinical diagnosis is generally based on clinical and laboratory findings.Recent guidelines recommend not performing diagnostic imaging unless a complicated APN is suspected or the infection affects high-risk patients such as the elderly,immunocompromised individuals,or diabetics.Contrast-enhanced ultrasound(CEUS)is a valuable tool in both the diagnosis and follow-up of APN.It aids in distinguishing small simple nephritic involvement from abscess complications and monitoring their evolution over time during antibiotic therapy.Given its lack of ionizing radiation and nephrotoxicity,CEUS is a valid diagnostic modality for approaching and monitoring pyelonephritis,improving early identification and characterization of inflammatory lesions.This review aims to summarize the main evidence on the use of ultrasound and CEUS in the diagnosis of APN and its follow-up.

Value of contrast-enhanced ultrasound in deep angiomyxoma using a biplane transrectal probe:A case report

BACKGROUND Deep angiomyxoma(DAM)is a very rare tumor type.Magnetic resonance imaging(MRI)is considered the best imaging modality for diagnosing DAM.Computed tomography(CT)is used mainly to assess the invasion range of DAM.The value of ultrasonography in the diagnosis of DAM is still controversial.Through a literature review,we summarized the current state of ultrasonic examination for DAM and reported for the first time the contrast-enhanced ultrasound(CEUS)features of DAM seen using a biplane transrectal probe.CASE SUMMARY A 37-year-old woman presented with a sacrococcygeal mass that had gradually increased in size over the previous 6 mo.MRI and CT examinations failed to allow a definite diagnosis to be made.Transperineal core needle biopsy(CNB)guided by transrectal ultrasound and CEUS was suggested after a multidisciplinary discussion.Grayscale ultrasound of the lesion showed a layered appearance with alternating hyperechoic and hypoechoic patterns.Transrectal CEUS showed a laminated distribution of the contrast agent that was consistent with the layered appearance of the tumor on grayscale ultrasound.We performed transperineal CNB of the enhanced area inside the tumor under transrectal CEUS guidance and finally made a definitive diagnosis of DAM through histopathology.The patient underwent laparoscopic-assisted transabdominal surgery combined with transperineal surgery for large pelvic tumor resection and pelvic floor peritoneal reconstruction.No recurrence or metastasis was found at the ninemonth follow-up.CONCLUSION Transrectal CEUS can show the layered perfusion characteristics of the contrast agent,guiding subsequent transperineal CNB of the enhanced area within the DAM.

Quantitative evaluation of colorectal tumour vasculature using contrast-enhanced ultrasound:Correlation with angiogenesis and prognostic significance

BACKGROUND Ultrasound is a vital tool for the diagnosis and management of colorectal cancer(CRC).Contrast-enhanced ultrasound(CEUS)is a non-invasive,safe,and cost-effective method for evaluating tumour blood vessels,that play a crucial role in tumour growth and progression.AIM To explore CEUS’s role in the quantitative evaluation of CRC blood vessels and their correlation with angiogenesis markers and prognosis.METHODS This study prospectively enrolled 100 patients with CRC confirmed by histo-pathology.All patients received preoperative CEUS examinations.Quantitative parameters,such as peak intensity(PI),time to peak(TTP),and area under the curve(AUC),were derived from time-intensity curve(TIC)analysis.Tumour tissue samples were obtained during surgery and examined immunohistochem-ically to assess the expression of angiogenesis markers,including vascular endo-thelial growth factor(VEGF)and microvessel density(MVD).The correlation between CEUS parameters,angiogenesis markers,and clinicopathological features was evaluated using appropriate statistical tests.RESULTS Quantitative CEUS parameters(PI,TTP,and AUC)showed significant correlations with VEGF expression(P<0.001)and MVD(P<0.001),indicating a strong link between tumour blood vessels and angiogenesis.Increased PI,reduced TTP,and expanded AUC values were significantly related to higher tumour stage(P<0.001),lymph node metastasis(P<0.001),and distant metastasis(P<0.001).Furthermore,these parameters were recognized as independent predictors of overall survival and disease-free survival in multivariate analysis(P<0.001).CONCLUSION CEUS has a high potential in guiding treatment planning and predicting patient outcomes.However,more com-prehensive,multicentre studies are required to validate the clinical utility of CEUS in CRC management.

Evaluation of the Therapeutic Effect of Contrast-Enhanced Ultrasound on Different Types of Knee Osteoarthritis in the Elderly

Objective: To evaluate the curative effect of the Traditional Chinese Medicine (TCM) external therapy on knee osteoarthritis patients with different TCM constitutions using musculoskeletal ultrasonography and contrast-enhanced ultrasonography, and to explore the application value of contrast-enhanced ultrasonography in knee joint diseases. Methods: A total of 57 patients diagnosed with knee osteoarthritis in Shaanxi University of Traditional Chinese Medicine from December 2019 to May 2021 were collected, and they were divided into qi stagnation and blood stasis type group (23 cases) and cold-dampness obstruction type group (34 cases) according to the traditional Chinese medicine method. All patients were given acupuncture combined with TCM fumigation and washing. All patients underwent musculoskeletal ultrasonography and contrast-enhanced ultrasonography before and after treatment, observed and recorded relevant data, and compared the treatment effects between the two groups. Results: 85.96% (49/57) of knee osteoarthritis (KOA) patients had suprapatellar bursa effusion, 42.1% (24/57) had iliotibial band bursae effusion, some of which had poor sound transmission, and thickened synovium was seen in most effusions, 33.33% (19/57) had osteophyte formation. Compared with before treatment, the depth of suprapatellar sac effusion in the Qi stagnation and blood stasis type group decreased after treatment (P Conclusion: Musculoskeletal contrast-enhanced ultrasonography was used to quantitatively evaluate the efficacy of TCM external therapy on KOA for different TCM constitutions. Dynamic observation of synovial lesions of knee osteoarthritis provides a valuable imaging method for evaluating the efficacy of traditional Chinese medicine.

新型^(18)F-FES PET/CT无创功能性诊断乳腺癌迟发性肺转移致霍纳综合征一例

激素受体阳性、人表皮生长因子受体2型阴性(HR^(+)/HER2^(-))乳腺癌是最常见的乳腺癌分子亚型,可表现为术后10~15年以上的迟发性复发,且其肺转移病灶需与原发性肺癌相鉴别。本文报道1例HR^(+)/HER2^(-)乳腺癌术后16年迟发性肺转移致霍纳综合征患者,采用^(18)F-FDG PET/CT难以判断肿瘤来源,穿刺活检风险高,经北京协和医院新型^(18)F-FES PET/CT无创功能性诊断为乳腺癌肺上叶雌激素受体(estrogen receptor,ER)阳性转移,给予CDK4/6抑制剂+芳香化酶抑制剂内分泌解救治疗后获得缓解。本文总结该患者的临床表现及诊治经过,为新型^(18)F-FES PET/CT评估乳腺癌患者转移灶的ER表达情况及指导后续个体化诊疗提供借鉴。

CT血管成像对ACI患者颈动脉狭窄程度及侧支循环的价值研究

目的分析、探究CT血管成像技术在ACI患者颈动脉狭窄、侧支循环等病情诊断方面的成效。方法对我院2021.3-2022.3月期间收治的100例急性脑梗死(ACI)患者一般病理资料进行回顾性分析,以数字减影血管造影(DSA)结果为诊断金标准,对CT血管成像技术(CTA)的诊断价值进行分析,以临床出具的数字减影血管造影(DSA)结果为金标准,分析CT血管成像技术(CTA)在临床上的诊断价值,评估此技术在临床诊断中的效能。结果与临床金标准相比,CTA诊断技术具有较高的临床评估价值[Kappa>0.8~1.0,曲线下面积(AUC)>0.9,P<0.01];CTA诊断技术在评估颈动脉狭窄程度等方面与临床金标准具有一定的一致性[Kappa>0.6~0.8,曲线下面积(AUC)>0.7~0.9,P<0.01];而在评估侧支循环临床诊断中,CTA诊断技术与临床金标准具有一致性,具有较高的评估价值[Kappa>0.8~1.0,曲线下面积(AUC)>0.9,P<0.01]。结论以临床“金标准”的诊断结果为依据分析,CTA诊断技术能够对ACI患者出现病变的血管形态及侧支循环状态等进行全面的评估,CTA诊断结果可为治疗工作提供准确性相对较高且客观的医学依据,确实是评估ACI患者颈动脉狭窄程度、侧支循环状态的可靠办法;而与DSA技术相比,CTA与之具有较高的一致性,说明在病情发作早期为ACI患者实施CTA检查可获悉颈动脉的狭窄及侧支循环状态,有利于改善患者群体的预后。

CT灌注成像参数对急性脑梗死侧支循环的评估价值及与术后近期预后的相关性

目的探讨CT灌注成像(CTPI)参数对急性脑梗死(ACI)侧支循环的评估价值及与术后近期预后的相关性。方法选取我院2022年1月-2023年2月收治的106例ACI患者,以数字血管造影(DSA)作为诊断“金标准”,将其分有侧支循环组(46例)与无侧支循环组(60例)。两组患者均进行CTPI检查,对比两组受试者CTPI参数[脑血容量(CBV)、脑血流量(CBF)、平均通过时间(MTT)及达峰时间(TTP)],采用受试者工作特征(ROC)曲线分析CTPI参数对ACI侧支循环的预测价值;比较CTPI参数评估急性缺血性脑梗死侧支循环与DSA检查的一致性;采用Pearson相关性分析ACI患者的CTPI参数与美国国立卫生研究院卒中量表(NIHSS)、改良Ranking量表(mRS)评分的相关性。结果有侧支循环组CBV、CBF均高于无侧支循环组(P<0.05),MTT、TTP均低于无侧支循环组(P<0.05)。ROC曲线分析显示,CBV、CBF、MTT、TTP及联合检测对ACI侧支循环均有预测效能(P<0.05),其AUC分别为0.793、0.705、0.841、0.669、0.879,单独检测中MTT效能最高,但仍低于联合检测效能。CTPI参数联合检查对ACI侧支循环的诊断灵敏性为84.78%、特异性为90.00%、准确率为87.74%、阳性预测值为86.67%、阴性预测值为88.52%、Kappa值为0.750。有侧支循环组NIHSS、mRS评分均低于无侧支循环组(P<0.05);Pearson相关分析发现,CBV、CBF与NIHSS、mRS评分呈负相关(P<0.05),MTT、TTP与NIHSS、mRS评分呈正相关(P<0.05)。结论ACI有侧支循环患者的CBV、CBF均较无侧支循环患者高,MTT、TTP均较无侧支循环患者低,CTPI参数用于评估ACI侧支循环具有较高的诊断效能,且有侧支循环患者近期预后较好,同时CBV、CBF、MTT、TTP与ACI患者近期预后均存在相关性,可通过检测CBV、CBF、MTT、TTP预测患者近期预后。

双能量CT非线性融合和噪声优化的虚拟单能量图像技术在喉鳞状细胞癌中的应用

目的:探讨双能量CT线性融合图像(linear blending imaging,LBI)、非线性融合图像(nonlinear blending image,NBI)和噪声优化的虚拟单能量图像(noise-optimized virtual monoenergetic image,VMI+)技术在喉鳞状细胞癌中的应用价值。方法:回顾性分析2019年6月至2022年3月61例经病理证实为喉鳞状细胞癌患者的双能量CT资料。双能量图像采用LBI[融合系数为1(80 kV)和0.6(M0.6)]、NBI和VMI+(40 keV、55 keV)技术重建。比较5组图像的客观图像质量[对比噪声比(contrast-tonoise ratio,CNR)、肿瘤CT值、噪声]和主观图像质量(肿瘤边界评分和整体图像质量评分)。结果:40 keV的CNR、肿瘤CT值和肿瘤边界评分均明显高于80 kV、M0.6、NBI和55 keV,差异均有统计学意义(均P<0.05)。NBI的整体图像质量评分明显高于80 kV、M0.6、40 keV和55 keV,差异均有统计学意义(均P<0.05)。NBI的噪声明显低于80 kV、40 keV和55 keV,差异均有统计学意义(均P<0.05)。结论:在喉鳞状细胞癌的双能量CT中,采用VMI+技术(40 keV)能提供更好的CNR、肿瘤CT值和肿瘤边界,采用NBI技术能提供更低的噪声和更好的整体图像质量。