The reliability and reliable indexes of q ua ntitative assessment of coronary flow reserve (CFR) by using time intensity cur ve (TIC) via myocardial contrast echocardiography were investigated. The TIC var iables wer...The reliability and reliable indexes of q ua ntitative assessment of coronary flow reserve (CFR) by using time intensity cur ve (TIC) via myocardial contrast echocardiography were investigated. The TIC var iables were obtained by employing acoustic densitometry (AD) technique before an d after acetylcholine (Ach) injection in 12 dogs. Meanwhile, the correlation be tween these variables and CFR was analyzed. Among the variables derived from TIC , peak intensity (PI), area under the curve (AUC) and descending slope (DS) were increased significantly ( P <0.05) with the increase of coronary blood flow a fter Ach injection. Conversely, time to peak (TP), half time of descent (HT) , and mean transit time (MTT) were decreased remarkably ( P <0.0001). Th e P I and AUC ratios from post to pre Ach injection were strongly associated with CFR with the correlation coefficient (r) being 0.8366 and 0.8824, respectively. It is reliable by using the variables derived from TIC with myocardial contrast echocardiography to quantitatively evaluate regional myocardial CFR. The PI an d AUC ratios from post to pre Ach injection are the reliable indexes for quan titative assessment of CFR.展开更多
In the current study, we sought to evaluate the diagnostic efficacies of conventional ultrasound（US）, contrastenhanced US（CEUS）, combined US and CEUS and magnetic resonance imaging（MRI） in detecting focal solid ...In the current study, we sought to evaluate the diagnostic efficacies of conventional ultrasound（US）, contrastenhanced US（CEUS）, combined US and CEUS and magnetic resonance imaging（MRI） in detecting focal solid breast lesions. Totally 117 patients with 120 BI-RADS category 4A-5 breast lesions were evaluated by conventional US and CEUS, and MRI, respectively. SonoVue was used as contrast agent in CEUS and injected as an intravenous bolus; nodule scan was performed 4 minutes after bolus injection. A specific sonographic quantification software was used to obtain color-coded maps of perfusion parameters for the investigated lesion, namely the time-intensity curve.The pattern of contrast enhancement and related indexes regarding the time-intensity curve were used to describe the lesions, comparatively with pathological results. Histopathologic examination revealed 46 benign and 74 malignant lesions. Sensitivity, specificity, and accuracy of US in detecting malignant breast lesions were 90.14%, 95.92%, and 92.52%, respectively. Meanwhile, CE-MRI showed sensitivity, specificity, and accuracy of 88.73%, 95.92%, and91.67%, respectively. The area under the ROC curve for combined US and CEUS in discriminating benign from malignant breast lesions was 0.936, while that of MRI was 0.923, with no significant difference between them, as well as among groups. The time-intensity curve of malignant hypervascular fibroadenoma and papillary lesions mostly showed a fast-in/fast-out pattern, with no good correlation between them（kappa 〈0.20）. In conclusion, the combined use of conventional US and CEUS displays good agreement with MRI in differentiating benign from malignant breast lesions.展开更多
AIM:To study the role of time-intensity curve(TIC) analysis parameters in a complex system of neural networks designed to classify liver tumors.METHODS:We prospectively included 112 patients with hepatocellular carcin...AIM:To study the role of time-intensity curve(TIC) analysis parameters in a complex system of neural networks designed to classify liver tumors.METHODS:We prospectively included 112 patients with hepatocellular carcinoma(HCC)(n = 41),hypervascular(n = 20) and hypovascular(n = 12) liver metastases,hepatic hemangiomas(n = 16) or focal fatty changes(n = 23) who underwent contrast-enhanced ultrasonography in the Research Center of Gastroenterology and Hepatology,Craiova,Romania.We recorded full length movies of all contrast uptake phases and post-processed them offline by selecting two areas of interest(one for the tumor and one for the healthy surrounding parenchyma) and consecutive TIC analysis.The difference in maximum intensities,the time to reaching them and the aspect of the late/portal phase,as quantified by the neural network and a ratio between median intensities of the central and peripheral areas were analyzed by a feed forward back propagation multi-layer neural network which was trained to classify data into five distinct classes,corresponding to each type of liver lesion.RESULTS:The neural network had 94.45% training accuracy(95% CI:89.31%-97.21%) and 87.12% testing accuracy(95% CI:86.83%-93.17%).The automatic classification process registered 93.2% sensitivity,89.7% specificity,94.42% positive predictive value and 87.57% negative predictive value.The artificial neural networks(ANN) incorrectly classified as hemangyomas three HCC cases and two hypervascular metastases,while in turn misclassifying four liver hemangyomas as HCC(one case) and hypervascular metastases(three cases).Comparatively,human interpretation of TICs showed 94.1% sensitivity,90.7% specificity,95.11% positive predictive value and 88.89% negative predictive value.The accuracy and specificity of the ANN diagnosis system was similar to that of human interpretation of the TICs(P = 0.225 and P = 0.451,respectively).Hepatocellular carcinoma cases showed contrast uptake during the arterial phase followed by wash-out in the portal and first seconds of the late phases.For the hypovascular metastases did not show significant contrast uptake during the arterial phase,which resulted in negative differences between the maximum intensities.We registered wash-out in the late phase for most of the hypervascular metastases.Liver hemangiomas had contrast uptake in the arterial phase without agent wash-out in the portallate phases.The focal fatty changes did not show any differences from surrounding liver parenchyma,resulting in similar TIC patterns and extracted parameters.CONCLUSION:Neural network analysis of contrastenhanced ultrasonography-obtained TICs seems a promising field of development for future techniques,providing fast and reliable diagnostic aid for the clinician.展开更多
目的:探讨经直肠超声造影(contrast-enhanced transrectal ultrasound)时间-强度曲线(time-intensity curve,TIC)参数评估前列腺癌(prostate cancer,PCa)患者对新辅助内分泌治疗(neoadjuvant hormonal therapy,NHT)的反应程度。方法:纳...目的:探讨经直肠超声造影(contrast-enhanced transrectal ultrasound)时间-强度曲线(time-intensity curve,TIC)参数评估前列腺癌(prostate cancer,PCa)患者对新辅助内分泌治疗(neoadjuvant hormonal therapy,NHT)的反应程度。方法:纳入27例接受NHT的PCa患者的临床资料,根据术后病理学检查结果分为有效组(n=16)和无效组(n=11)。对比两组患者临床病理学特征、治疗前后血清前列腺特异性抗原(prostate-specific antigen,PSA)和CETRUS检查指标及其变化率,以筛选与NHT反应性有关的潜在指标。进一步采用相关性分析评价其在评估患者对NHT反应方面的价值。结果:有效组和无效组在临床病理学特征、治疗前的血清PSA和C E T R U S检查指标方面的差异无统计学意义(均P>0.05)。治疗后,仅有效组的TIC曲线下面积(area under curve,AUC)低于无效组(560 dB·s vs 710 dB·s),其变化率大于无效组(-27.1%vs-5.3%)(均P<0.05)。相关性分析显示AUC变化率与组织学反应评分之间的相关性略高于治疗后AUC(r为-0.690 vs-0.630)。结论:CETRUS TIC参数中,NHT后的AUC及其变化率在评估PCa患者对NHT反应方面具有较好的价值。其中,AUC变化率可能与治疗反应程度更相关。展开更多
目的利用超声造影(CEUS)定量分析技术获取不同甲状腺结节的定量参数,评价其对低增强型亚急性甲状腺炎(SAT)与甲状腺乳头状癌(PTC)的鉴别诊断价值。方法选择32例SAT患者作为SAT组,其中男性6例,女性26例;年龄36~66岁,平均年龄50.37岁;结...目的利用超声造影(CEUS)定量分析技术获取不同甲状腺结节的定量参数,评价其对低增强型亚急性甲状腺炎(SAT)与甲状腺乳头状癌(PTC)的鉴别诊断价值。方法选择32例SAT患者作为SAT组,其中男性6例,女性26例;年龄36~66岁,平均年龄50.37岁;结节大小6.0~36.7 mm,平均最大径13.54 mm。同期选择经术后病理诊断证实39例PTC患者作为PTC组,其中男性9例,女性30例;年龄33~66岁,平均年龄48.28岁;结节大小7.0~23.0 mm,平均最大径11.94 mm。运用SonoLiver软件分析记录各结节整体(W)、边缘(P)和中央(C)的不同感兴趣区(ROI)的CEUS定量参数,包括最大峰值强度(IMAX)、始增时间(RT)、达峰时间(TTP)和平均渡越时间(mTT),并计算周围正常组织各定量参数与结节不同部位定量参数的相对值(△值),对比分析SAT和PTC两组结节之间CEUS定量参数的差异,并用受试者工作特性(ROC)曲线获得截断值。结果SAT组结节定量参数IMAX_(W)和△mTT_(W)大于PTC组(0.53±0.18 vs 0.43±0.23;P<0.05。-1.26±7.35 vs-1.44±2.38;P<0.05);△TTP_(P)在SAT组小于PTC组(-0.42±0.66 vs 0.06±0.75。P<0.05);SAT组定量参数IMAX_(C)、△RT_(C)及△mTT_(C)均高于PTC组(0.49±0.19 vs 0.31±0.28;P<0.05。0.24±0.62 vs-0.28±1.11;P<0.05。1.31±4.32 vs-1.62±4.35;P<0.05)。ROC曲线分析显示定量参数IMAX_(C)及△mTT_(C)的最佳截断值分别为0.27和0.50,曲线下面积分别为0.849和0.837。结论CEUS定量分析有助于低增强型SAT与PTC的鉴别,有一定的临床应用价值。展开更多
Background Assessment of perfusion in the early period of acute renal failure （ARF） is important,and can not be made by conventional ultrasound.The aim of this study was to prospectively test in a rabbit ARF model w...Background Assessment of perfusion in the early period of acute renal failure （ARF） is important,and can not be made by conventional ultrasound.The aim of this study was to prospectively test in a rabbit ARF model whether real-time contrast-enhanced ultrasound （CEUS） can quantitatively evaluate the hemodynamic changes of renal cortex in the early period.Methods The model of ARF was induced in 30 healthy New Zealand white rabbits （2.5-3.0 kg）,by intramuscular injection of 50% glycerin solution （12 ml/kg）.CEUS were performed on right kidneys before,6 and 24 hours after glycerin injection.CEUS quantitative indexes were measured in renal cortex using QLAB software.Comparisons between different stages were performed using paired t test.The sensitivity of CEUS in diagnosing ARF was compared with blood serum urea nitrogen （BUN）,serum creatinine （SCr） level and color Doppler flow imaging （CDFI）.Results Among quantitative indexes,time to peak （TTP） and area under curve （AUC） increased significantly from （5.86±2.57） seconds and （124.4±46.7） dB.s before glycerin injection to （7.66±2.05） seconds and （288.1±64.9） dB.s 6 hours after injection （P 〈0.05）.Slope rate of ascending curve （A） and descending curve （α） decreased slightly from （3.00±1.22） dB/s and （0.19±0.15） 1/s to （2.80±1.45） dB.s and （0.09±0.02） 1/s （P 〈0.05）.Twenty-four hours later,only AUC increased significantly from （124.4±46.7） dB.s to （466.2±52.2） dB.s （P〈0.05）.Conclusion Quantitative indexes of CEUS might be useful in predicting the hemodynamic changes of renal cortex in the early six hours of ARF model.展开更多
文摘The reliability and reliable indexes of q ua ntitative assessment of coronary flow reserve (CFR) by using time intensity cur ve (TIC) via myocardial contrast echocardiography were investigated. The TIC var iables were obtained by employing acoustic densitometry (AD) technique before an d after acetylcholine (Ach) injection in 12 dogs. Meanwhile, the correlation be tween these variables and CFR was analyzed. Among the variables derived from TIC , peak intensity (PI), area under the curve (AUC) and descending slope (DS) were increased significantly ( P <0.05) with the increase of coronary blood flow a fter Ach injection. Conversely, time to peak (TP), half time of descent (HT) , and mean transit time (MTT) were decreased remarkably ( P <0.0001). Th e P I and AUC ratios from post to pre Ach injection were strongly associated with CFR with the correlation coefficient (r) being 0.8366 and 0.8824, respectively. It is reliable by using the variables derived from TIC with myocardial contrast echocardiography to quantitatively evaluate regional myocardial CFR. The PI an d AUC ratios from post to pre Ach injection are the reliable indexes for quan titative assessment of CFR.
基金supported by the Natural Science Foundation of Jiangsu University(14KJB320003)
文摘In the current study, we sought to evaluate the diagnostic efficacies of conventional ultrasound（US）, contrastenhanced US（CEUS）, combined US and CEUS and magnetic resonance imaging（MRI） in detecting focal solid breast lesions. Totally 117 patients with 120 BI-RADS category 4A-5 breast lesions were evaluated by conventional US and CEUS, and MRI, respectively. SonoVue was used as contrast agent in CEUS and injected as an intravenous bolus; nodule scan was performed 4 minutes after bolus injection. A specific sonographic quantification software was used to obtain color-coded maps of perfusion parameters for the investigated lesion, namely the time-intensity curve.The pattern of contrast enhancement and related indexes regarding the time-intensity curve were used to describe the lesions, comparatively with pathological results. Histopathologic examination revealed 46 benign and 74 malignant lesions. Sensitivity, specificity, and accuracy of US in detecting malignant breast lesions were 90.14%, 95.92%, and 92.52%, respectively. Meanwhile, CE-MRI showed sensitivity, specificity, and accuracy of 88.73%, 95.92%, and91.67%, respectively. The area under the ROC curve for combined US and CEUS in discriminating benign from malignant breast lesions was 0.936, while that of MRI was 0.923, with no significant difference between them, as well as among groups. The time-intensity curve of malignant hypervascular fibroadenoma and papillary lesions mostly showed a fast-in/fast-out pattern, with no good correlation between them（kappa 〈0.20）. In conclusion, the combined use of conventional US and CEUS displays good agreement with MRI in differentiating benign from malignant breast lesions.
文摘AIM:To study the role of time-intensity curve(TIC) analysis parameters in a complex system of neural networks designed to classify liver tumors.METHODS:We prospectively included 112 patients with hepatocellular carcinoma(HCC)(n = 41),hypervascular(n = 20) and hypovascular(n = 12) liver metastases,hepatic hemangiomas(n = 16) or focal fatty changes(n = 23) who underwent contrast-enhanced ultrasonography in the Research Center of Gastroenterology and Hepatology,Craiova,Romania.We recorded full length movies of all contrast uptake phases and post-processed them offline by selecting two areas of interest(one for the tumor and one for the healthy surrounding parenchyma) and consecutive TIC analysis.The difference in maximum intensities,the time to reaching them and the aspect of the late/portal phase,as quantified by the neural network and a ratio between median intensities of the central and peripheral areas were analyzed by a feed forward back propagation multi-layer neural network which was trained to classify data into five distinct classes,corresponding to each type of liver lesion.RESULTS:The neural network had 94.45% training accuracy(95% CI:89.31%-97.21%) and 87.12% testing accuracy(95% CI:86.83%-93.17%).The automatic classification process registered 93.2% sensitivity,89.7% specificity,94.42% positive predictive value and 87.57% negative predictive value.The artificial neural networks(ANN) incorrectly classified as hemangyomas three HCC cases and two hypervascular metastases,while in turn misclassifying four liver hemangyomas as HCC(one case) and hypervascular metastases(three cases).Comparatively,human interpretation of TICs showed 94.1% sensitivity,90.7% specificity,95.11% positive predictive value and 88.89% negative predictive value.The accuracy and specificity of the ANN diagnosis system was similar to that of human interpretation of the TICs(P = 0.225 and P = 0.451,respectively).Hepatocellular carcinoma cases showed contrast uptake during the arterial phase followed by wash-out in the portal and first seconds of the late phases.For the hypovascular metastases did not show significant contrast uptake during the arterial phase,which resulted in negative differences between the maximum intensities.We registered wash-out in the late phase for most of the hypervascular metastases.Liver hemangiomas had contrast uptake in the arterial phase without agent wash-out in the portallate phases.The focal fatty changes did not show any differences from surrounding liver parenchyma,resulting in similar TIC patterns and extracted parameters.CONCLUSION:Neural network analysis of contrastenhanced ultrasonography-obtained TICs seems a promising field of development for future techniques,providing fast and reliable diagnostic aid for the clinician.
文摘目的:探讨经直肠超声造影(contrast-enhanced transrectal ultrasound)时间-强度曲线(time-intensity curve,TIC)参数评估前列腺癌(prostate cancer,PCa)患者对新辅助内分泌治疗(neoadjuvant hormonal therapy,NHT)的反应程度。方法:纳入27例接受NHT的PCa患者的临床资料,根据术后病理学检查结果分为有效组(n=16)和无效组(n=11)。对比两组患者临床病理学特征、治疗前后血清前列腺特异性抗原(prostate-specific antigen,PSA)和CETRUS检查指标及其变化率,以筛选与NHT反应性有关的潜在指标。进一步采用相关性分析评价其在评估患者对NHT反应方面的价值。结果:有效组和无效组在临床病理学特征、治疗前的血清PSA和C E T R U S检查指标方面的差异无统计学意义(均P>0.05)。治疗后,仅有效组的TIC曲线下面积(area under curve,AUC)低于无效组(560 dB·s vs 710 dB·s),其变化率大于无效组(-27.1%vs-5.3%)(均P<0.05)。相关性分析显示AUC变化率与组织学反应评分之间的相关性略高于治疗后AUC(r为-0.690 vs-0.630)。结论:CETRUS TIC参数中,NHT后的AUC及其变化率在评估PCa患者对NHT反应方面具有较好的价值。其中,AUC变化率可能与治疗反应程度更相关。
文摘目的利用超声造影(CEUS)定量分析技术获取不同甲状腺结节的定量参数,评价其对低增强型亚急性甲状腺炎(SAT)与甲状腺乳头状癌(PTC)的鉴别诊断价值。方法选择32例SAT患者作为SAT组,其中男性6例,女性26例;年龄36~66岁,平均年龄50.37岁;结节大小6.0~36.7 mm,平均最大径13.54 mm。同期选择经术后病理诊断证实39例PTC患者作为PTC组,其中男性9例,女性30例;年龄33~66岁,平均年龄48.28岁;结节大小7.0~23.0 mm,平均最大径11.94 mm。运用SonoLiver软件分析记录各结节整体(W)、边缘(P)和中央(C)的不同感兴趣区(ROI)的CEUS定量参数,包括最大峰值强度(IMAX)、始增时间(RT)、达峰时间(TTP)和平均渡越时间(mTT),并计算周围正常组织各定量参数与结节不同部位定量参数的相对值(△值),对比分析SAT和PTC两组结节之间CEUS定量参数的差异,并用受试者工作特性(ROC)曲线获得截断值。结果SAT组结节定量参数IMAX_(W)和△mTT_(W)大于PTC组(0.53±0.18 vs 0.43±0.23;P<0.05。-1.26±7.35 vs-1.44±2.38;P<0.05);△TTP_(P)在SAT组小于PTC组(-0.42±0.66 vs 0.06±0.75。P<0.05);SAT组定量参数IMAX_(C)、△RT_(C)及△mTT_(C)均高于PTC组(0.49±0.19 vs 0.31±0.28;P<0.05。0.24±0.62 vs-0.28±1.11;P<0.05。1.31±4.32 vs-1.62±4.35;P<0.05)。ROC曲线分析显示定量参数IMAX_(C)及△mTT_(C)的最佳截断值分别为0.27和0.50,曲线下面积分别为0.849和0.837。结论CEUS定量分析有助于低增强型SAT与PTC的鉴别,有一定的临床应用价值。
文摘Background Assessment of perfusion in the early period of acute renal failure （ARF） is important,and can not be made by conventional ultrasound.The aim of this study was to prospectively test in a rabbit ARF model whether real-time contrast-enhanced ultrasound （CEUS） can quantitatively evaluate the hemodynamic changes of renal cortex in the early period.Methods The model of ARF was induced in 30 healthy New Zealand white rabbits （2.5-3.0 kg）,by intramuscular injection of 50% glycerin solution （12 ml/kg）.CEUS were performed on right kidneys before,6 and 24 hours after glycerin injection.CEUS quantitative indexes were measured in renal cortex using QLAB software.Comparisons between different stages were performed using paired t test.The sensitivity of CEUS in diagnosing ARF was compared with blood serum urea nitrogen （BUN）,serum creatinine （SCr） level and color Doppler flow imaging （CDFI）.Results Among quantitative indexes,time to peak （TTP） and area under curve （AUC） increased significantly from （5.86±2.57） seconds and （124.4±46.7） dB.s before glycerin injection to （7.66±2.05） seconds and （288.1±64.9） dB.s 6 hours after injection （P 〈0.05）.Slope rate of ascending curve （A） and descending curve （α） decreased slightly from （3.00±1.22） dB/s and （0.19±0.15） 1/s to （2.80±1.45） dB.s and （0.09±0.02） 1/s （P 〈0.05）.Twenty-four hours later,only AUC increased significantly from （124.4±46.7） dB.s to （466.2±52.2） dB.s （P〈0.05）.Conclusion Quantitative indexes of CEUS might be useful in predicting the hemodynamic changes of renal cortex in the early six hours of ARF model.
