Changes in three-dimensional power Doppler ultrasound features before and after neoadjuvant chemotherapy for cervical cancer and their relationship with malignant molecule expression

Objective:To study the changes in three-dimensional power Doppler ultrasound features before and after neoadjuvant chemotherapy for cervical cancer and their relationship with malignant molecule expression.Methods: The patients who were diagnosed with cervical cancer and received neoadjuvant chemotherapy in Wuhan Red Cross Hospital between March 2015 and October 2017 were selected as the cervical cancer group, and the patients who received cervical biopsy and were diagnosed with stage I cervical intraepithelial neoplasia by pathological findings during the same period were selected as the control group. Before biopsy, three-dimensional power Doppler ultrasonography was performed to measure VI, FI and VFI;the tissues of cervical cancer group before and after chemotherapy as well as the biopsy tissues of control group were collected to measure the expression of proliferation genes, invasion genes and angiogenesis genes.Results: The VI, FI and VFI levels as well as the Piwil2 gene (Piwil2), CyclinD1, N-Myc downstream regulated gene 3 (NDRG3), CXC chemokine ligand 5 (CXCL5), cathepsin-L (CAT-L), EGF-containing fibulin-like extracellular matrix protein 1 (EFEMP1), angiotensin (Ang)1, Ang2 and angiopoietin-like protein 4 (ANGPTL4) mRNA expression levels in the tissues of cervical cancer group before and after chemotherapy were all significantly higher than those of control group whereas the thrombospondin 2 (THBS2), Smac gene (Smac), large tumor suppressor kinase 1 (LATS1), reversion-inducing-cysteine-rich protein with kazal motifs (RECK) and plas minogen activator inhibitor 1 (PAI-1) mRNA expression levels in the tissues were all significantly lower than those of control group, and the VI, FI and VFI levels as well as the Piwil2, CyclinD1, NDRG3, CXCL5, CAT-L, EFEMP1, Ang1, Ang2 and ANGPTL4 mRNA expression levels in the tissues of cervical cancer group after chemotherapy were all significantly lower than those before chemotherapy whereas the THBS2, Smac, LATS1, RECK and PAI-1 mRNA expression levels were all significantly higher than those before chemotherapy;the VI, FI and VFI levels in cervical cancer tissues were positively correlated with the Piwil2, CyclinD1, NDRG3, CXCL5, CAT-L, EFEMP1, Ang1, Ang2 and ANGPTL4 mRNA expression levels, and negatively correlated with the THBS2, Smac, LATS1, RECK and PAI-1 mRNA expression levels.Conclusion: The changes in the three-dimensional power Doppler ultrasound parameters before and after neoadjuvant chemotherapy for cervical cancer can reflect the changes in proliferation, invasion and angiogenesis gene expression in the lesions.

Antidiastole Value of Three-dimensional Ultrasonography and Power Doppler between Uterine Parenchyma Lumps and Endometrial Cancer:A Retrospective Study

Sometimes endometrial polyps,submucosal myomas,and endometrial cancer show similar findings under ultrasonography.The aim of this study was to assess the antidiastole value of blood flow parameters using three-dimensional(3D)power Doppler ultrasonography angiography(PDA)between endometrial cancer and uterine parenchyma lumps.The data of the blood flow indices in 3D-PDA including the vascularization index(VI),flow index(FI),and vascularization flow index(VFI)in 40 patients with endometrial cancer and 41 patients with uterine parenchyma lumps(endometrial polyps and submucosal myomas)were retrospectively analysed and compared utilizing Virtual Organ Computer-aided AnaLysis(VOCAL)software.The results showed that all the blood flow parameters(VI,FI,VFI)were significantly higher in women with endometrial cancer than in those with uterine parenchyma lumps(P<0.001).The area under the curve of ROC of VI,FI,and VFI was 0.98,0.84,and 0.97,respectively.Thus,the best predictor of endometrial carcinoma was VI with a sensitivity of 97.0% and a specificity of 91.0%.The optimal cutoff value of VI was 4.06%.Our data demonstrated that all of the blood flow signal parameters(including VI,FI,and VFI)in 3D power Doppler ultrasonography had significant antidiastole values between endometrial cancer and uterine parenchyma lumps to assist clinicians in properly diagnosing patients.

The correlation of vascularization index and flow index of thyroid cancer ultrasound with tumor malignancy

Objective:To study the correlation of ultrasound vascularization index and flow index of thyroid cancer with tumor malignancy.Methods: A total of 140 patients with thyroid nodule who accepted surgical resection in our hospital between May 2013 and June 2016 were selected as the research subjects, the patients with malignant thyroid nodule were included in the malignant group of the research and patients with benign thyroid nodule were included in the benign group of research. Three-dimensional power Doppler ultrasonography was conducted before operation to determine vascularization index (VI), flow index (FI) and vascularization flow index (VFI);tumor tissues were collected after operation to detect the expression of angiogenesis as well as cell proliferation, apoptosis and invasion-related molecules.Results:VI, FI and VFI levels of tumor tissue of malignant group were significantly higher than those of benign group;VEGF, MK, Ang-2, IGF-Ⅱ, Bcl-2, Livin, Wip1, S100A4, TCF,β-catenin and SATB1 protein expression in tumor tissue of malignant group were significantly higher than those of benign group and positively correlated with VI, FI and VFI levels while CCNG2 and p27 protein expression were significantly lower than those of benign group and negatively correlated with VI, FI and VFI levels.Conclusion:Ultrasound vascularization index and flow index of thyroid cancer increase significantly and are closely related to the angiogenesis as well as cell proliferation, apoptosis and invasion.

三维能量多普勒超声血流定量参数测定对子宫内膜良恶性病变的诊断价值

目的探讨三维能量多普勒超声血流定量参数测定对子宫内膜良、恶性病变的诊断价值。方法选取2018年4月至2019年4月就诊的子宫内膜病变患者,取患者子宫内膜病灶组织,常规制备切片,采用SP免疫组化法染色计算病灶组织微血管数量均值(MVD值);使用三维能量多普勒超声测定病灶区域血流定量参数,每个病变区均进行3次扫描,计算均值;以临床组织病理学诊断结果为标准,将子宫内膜良恶性疾病不同血流定量参数[血管指数(VI)、血流指数(FI)、血管、血流指数(VFI)]进行对比。结果子宫内膜癌组患者病灶组织MVD值高于良性疾病组(P<0.05),病变区域三维能量多普勒超声血流定量参数中VI、FI及VFI均显著高于良性疾病组(P<0.05),而子宫内膜癌患者的MVD、VI、FI值随病变分期的提高而明显升高,各组间比较差异有统计学意义(P<0.05),血流定量参数指标中VF、FI值与组织病理学测定MVD值呈正相关(r值分别为0.765、0.673,P<0.01)。结论三维能量多普勒超声血流定量参数测定可作为子宫内膜病良、恶性变鉴别诊断的重要依据。

腕指关节高频超声在类风湿关节炎诊断及鉴别诊断中的应用价值

目的:探讨腕、指关节高频超声(high-frequency ultrasound,HFUS)在类风湿关节炎(reheumatoid arthritis,RA)与手骨关节炎(osteoarthritis,OA)诊断及鉴别诊断中的价值,分析超声半定量评分在评估RA疾病活动度中的应用价值。方法:选取RA患者54例,手骨关节炎患者30例作为对照组,分别行腕关节、掌指关节、近指关节超声检查,检测两组滑膜厚度、滑膜血流、骨侵蚀及腱鞘炎,并对RA组上述4项观察指标进行超声半定量评分,同时记录RA组患者ESR、CRP、RF、CCP抗体、DAS28评分,分析超声评分与临床指标之间的相关性。结果:RA组在滑膜增生、滑膜血流、骨侵蚀、腱鞘炎方面较OA组明显增多(P<0.01);超声半定量评分与DAS28评分存在正相关(r=0.550,P<0.05)。结论:高频超声对RA及手OA患者诊断及鉴别诊断有一定价值;超声半定量评分可以反映RA疾病活动度。

宫内发育迟缓胎儿胎盘三维能量多普勒及GADD153表达的对比研究

目的:探讨宫内发育迟缓(IUGR)胎儿的胎盘三维能量多普勒(3D-PDU)与GADD153表达对比研究的临床意义。方法:选取就诊的胎儿宫内发育迟缓孕妇50例为试验组,正常妊娠孕妇30例为对照组。两组孕妇均行3D-PDU和VOCAL软件三维重建技术检测胎儿胎盘血流参数:血管化指数(VI)、血流指数(FI)和血管化血流指数(VFI),同时观察胎盘一、二、三级绒毛动脉显示率;抽取孕妇血清和分娩后的胎盘组织,采用ELISA和实时荧光定量法,检测两组孕妇血清及胎盘组织中GADD153的蛋白含量和mRNA水平。结果:3D-PDU和免疫学检测可见,与对照组比较,宫内发育迟缓孕妇的VI、FI、VFI均降低,胎盘一、二、三级绒毛动脉显示率低,孕妇血清及胎盘组织中GADD153的蛋白含量和mRNA水平均明显增高,差异有统计学意义(P<0.01)。结论:3D-PDU技术能精确地反映胎盘血流灌注情况,联合孕妇血清中GADD153蛋白含量和mRNA水平的检测,对预判胎盘功能及胎儿宫内发育迟缓具有重要临床意义。

探讨定量三维能量多普勒超声在评估妊高症产妇药物治疗效果中的应用价值

目的探讨定量三维能量多普勒超声技术在评估硫酸镁、硝苯地平治疗妊娠期高血压疾病患者疗效中的应用价值。方法选取2018年1月—2019年6月本院收治的76例妊娠期高血压患者作为研究对象,其中子痫前期轻度(A组)患者31例,子痫前期重度(B组)患者45例,所有患者均接受常规药物治疗(硫酸镁+硝苯地平+丹参),另选取正常孕妇50名作为对照组,通过定量三维能量多普勒超声技术评估妊高症患者的治疗效果。结果治疗前胎盘血流灌注监测结果提示三组胎盘动脉血流参数(VI、FI、VFI)、脐动脉S/D指标比较均存在显著差异(P<0.05),并且A、B组胎儿大脑中动脉PI、左子宫动脉PI、右子宫动脉PI、Apgar评分均明显低于对照组(P<0.05),并且A组大脑中动脉PI、左子宫动脉PI、右子宫动脉PI、Apgar评分明显低于B组(P<0.05);治疗后A、B组三位能量指数相关指标与对照组比较无显著差异(P>0.05);A组患者治疗总有效率略高与B组,但统计学无显著差异(P>0.05),并且治疗后不同疗效分级患者VI、FI、VFI指标比较存在显著差异(P>0.05)。结论硫酸镁、硝苯地平联合丹参治疗妊高症患者疗效可靠,通过定量三维能量多普勒超声进行胎盘血流灌注的监测可实现妊高症患者疗效的准确、客观评估,具有临床应用及推广价值。

肾脏超声和血清胱抑素对急性肾损伤的预测价值:在心力衰竭与脓毒症患者中的不同之处

目的 比较肾动脉阻力指数(RRI)、能量多普勒超声(PDU)评分及血清胱抑素C(Cys C)对重症医学科(ICU)急性心力衰竭(心衰)和脓毒症患者发生急性肾损伤(AKI)的预测价值.方法 采用前瞻性观察性研究方法,将2018年1月1日至12月31日入住沧州市中心医院急诊ICU的急性心衰和脓毒症患者作为研究对象.记录患者一般资料;于入ICU 6 h内测定血清Cys C水平,并计算RRI、PDU评分;入ICU 5 d用改善全球肾脏病预后组织(KDIGO)标准评估肾功能.将入ICU 5 d内进展为AKI 2期或3期的患者纳入AKI 2~3期组,未发生AKI或发生AKI 1期的患者纳入AKI 0~1期组;在所有患者、心衰患者、脓毒症患者中比较不同AKI分期两组间各指标的差异;采用多因素二元Logistic回归分析发生AKI的独立危险因素;并绘制受试者工作特征曲线(ROC),分析Cys C、RRI、PDU评分、RRI+PDU对患者发生AKI 2~3期的预测价值.结果 共纳入37例心衰患者(无AKI 11例,AKI 1期10例,AKI 2期3例,AKI 3期13例)和26例脓毒症患者(无AKI 8例,AKI 1期2例,AKI 2期7例,AKI 3期9例).在所有患者或心衰患者中,与AKI 0~1期组比较,AKI 2~3期组急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)、连续性肾脏替代治疗(CRRT)比例、28 d病死率、血肌酐(SCr)、Cys C、RRI较高,而尿量、PDU评分较低;在脓毒症患者中,与AKI 0~1期组比较,AKI 2~3期组CRRT比例、SCr、Cys C较高,而尿量较少.Logistic回归分析显示, Cys C和PDU评分是所有患者发生AKI 2~3期的独立危险因素〔Cys C :优势比(OR)=11.294,95%CI可信区间(95%CI)为2.801~45.541,P=0.001;PDU评分:OR=0.187,95%CI为0.056~0.627,P=0.007〕;RRI和PDU评分是心衰患者发生AKI 2~3期的独立危险因素〔RRI(×10):OR=6.172,95%CI为0.883~43.153, P=0.067;PDU评分:OR=0.063,95%CI为0.007~0.584,P=0.015〕;Cys C是脓毒症患者发生AKI 2~3期的独立危险因素(OR=22.830,95%CI为1.345~387.623,P=0.030).ROC曲线分析显示,在心衰患者中,RRI、PDU评分、Cys C对AKI 2~3期的预测价值较好〔ROC曲线下面积(AUC,95%CI)分别为0.839(0.673~0.942)、0.894(0.749~0.971)、0.777(0.610~0.897),均P<0.01〕;其中RRI+PDU的预测价值最高(AUC=0.956,95%CI为0.825~0.997,P<0.01),且高于单用Cys C的预测价值 〔AUC(95%CI): 0.956(0.825~0.997)比0.777(0.610~0.897),P=0.034〕.在脓毒症患者中,血清Cys C水平对AKI 2~3期的预测价值较好(AUC=0.913,95%CI为0.735~0.987,P<0.01),而RRI、PDU及RRI+PDU对AKI 2~3期无预测价值.结论 RRI和PDU评分对急性心衰患者AKI的预测价值良好,而对脓毒症患者AKI无预测价值;血清Cys C对心衰和脓毒症患者AKI的预测价值相似.

PDUS半定量分级、SWE对甲状腺结节的定性诊断价值及其与组织病理结构的关联关系分析

目的:探讨分析能量多普勒超声(PDUS)半定量分级、剪切波弹性成像(SWE)对甲状腺结节的定性诊断价值,并探讨其与组织病理结构的关联关系。方法:170例甲状腺结节患者均行PDUS和SWE检查。以病理结果为金标准,分析PDUS半定量分级、SWE单独及联合应用检查对甲状腺结节良恶性的定性诊断效能。并根据术后病理组织结构中实质及间质的排列分布情况进行分析,以多因素Logistic回归分析PDUS半定量分级、SWE结果和组织病理结构学的关联影响关系。结果:PDUS联合SWE诊断甲状腺结节良恶性的Kappa值、灵敏度、特异度、准确度均明显高于两法单独诊断。多因素Logistic回归分析发现,各组织学特征与PDUS半定量分级关联程度依次为:广泛纤维化>乳头结构>微滤泡结构;各组织学特征与SWE关联程度依次为:广泛纤维化>乳头结构>炎性细胞浸润>局部纤维化。结论:PDUS半定量分级联合SWE可显著提高甲状腺结节良恶性的定性诊断价值,且间质广泛纤维化是影响PDUS和SWE检测甲状腺结节的最显著组织病理因素。