AIM: To differentiate focal liver lesions based on enhancement patterns using three-dimensional ultrasonography (3D US) with perflubutane-based contrast agent.METHODS: Two hundred and eighty two patients with focal li...AIM: To differentiate focal liver lesions based on enhancement patterns using three-dimensional ultrasonography (3D US) with perflubutane-based contrast agent.METHODS: Two hundred and eighty two patients with focal liver lesions,including 168 hepatocellular carcinomas (HCCs),63 metastases,40 hemangiomas and 11 focal nodular hyperplasias (FNHs),were examined by 3D US with perflubutane-based contrast agent.Tomographic ultrasound images and sonographic angiograms were reconstructed.Among 282 lesions,enhancement patterns of 163 lesions between January 2007 and October 2007 were analyzed retrospectively.Then from November 2007 to May 2008,compared with contrast-enhanced (CE) 2D US,CE 3D US was performed on 119 lesions for prospective differential diagnosis.Sensitivity,specificity,area under receiver operating characteristic curve (Az) and inter-reader agreement were assessed.RESULTS: With the tridimensional view,dominant enhancement patterns were revealed as diffuse enhancement or peripheral ring-like enhancement,followed with washout change for HCCs or metastases,respectively,and peripheral nodular enhancement or diffuse enhancement with spoke-wheel arteries,followed by persistent enhancement for hemangiomas or FNHs,respectively.At CE 3D US,the prospective differentiation of lesions showed sensitivity 92% (mean for two readers),specificity 91% and Az value 0.95 for HCCs,84%,97%,and 0.95 for metastases,91%,98%,and 0.98 for hemangiomas and 80%,99%,and 0.99 for FNHs,respectively,while good to excellent inter-reader agreement was achieved.No significant difference exists between prospective diagnosis accuracy at CE 3D US and that at CE 2D US.CONCLUSION: CE 3D US provides a spatial perspective for liver tumor enhancement,and could help in differentiating focal liver lesions.展开更多
Objective To quantitatively analyze the fetal lung echo and right lung volume in the third trimester by real-time three-dimensional ultrasound(3-D US)and evaluate the feasibility of fetal lung maturity.Methods A total...Objective To quantitatively analyze the fetal lung echo and right lung volume in the third trimester by real-time three-dimensional ultrasound(3-D US)and evaluate the feasibility of fetal lung maturity.Methods A total of 732 women with normal singleton pregnancies between 28 and 42 weeks of gestation underwent ultrasound examination.The 3-D US equipment with a 3.5-5 MHz transabdominal transducer was used for the fetal biometric measurement.The echogenicity ratio between fetal lung and liver was compared.The fetal lung volume was calculated by the rotational multiplanar technique for volume measurement(VOCAL).Results The right fetal lung volume increased with the increase of gestational age with a linear positive correlation(r=0.884,P<0.01).After 34 weeks,the echogenicity ratio of fetal lung to liver was more than 1.1.Conclusion The echogenicity of lung/liver and fetal lung volume could be used as normal fetal predictable indicators for fetal lung maturity.展开更多
BACKGROUND Lateral facial clefts are atypical with a low incidence in the facial cleft spectrum.With the development of ultrasonography(US)prenatal screening,such facial malformations can be detected and diagnosed pre...BACKGROUND Lateral facial clefts are atypical with a low incidence in the facial cleft spectrum.With the development of ultrasonography(US)prenatal screening,such facial malformations can be detected and diagnosed prenatally rather than at birth.Although three-dimensional US(3DUS)can render the fetus'face via 3D reconstruction,the 3D images are displayed on two-dimensional screens without field depth,which impedes the understanding of untrained individuals.In contrast,a 3D-printed model of the fetus'face helps both parents and doctors develop a more comprehensive understanding of the facial malformation by creating more interactive aspects.Herein,we present an isolated lateral facial cleft case that was diagnosed via US combined with a 3D-printed model.CASE SUMMARY A 31-year-old G2P1 patient presented for routine prenatal screening at the 22nd wk of gestation.The coronal nostril-lip section of two-dimensional US(2DUS)demonstrated that the fetus'bilateral oral commissures were asymmetrical,and left oral commissure was abnormally wide.The left oblique-coronal section showed a cleft at the left oral commissure which extended to the left cheek.The results of 3DUS confirmed the cleft.Furthermore,we created a model of the fetal face using 3D printing technology,which clearly presented facial malformations.The fetus was diagnosed with a left lateral facial cleft,which was categorized as a No.7 facial cleft according to the Tessier facial cleft classification.The parents terminated the pregnancy at the 24th wk of gestation after parental counseling.CONCLUSION In the diagnostic course of the current case,in addition to the traditional application of 2D and 3DUS,we created a 3D-printed model of the fetus,which enhanced diagnostic evidence,benefited the education of junior doctors,improved parental counseling,and had the potential to guide surgical planning.展开更多
To investigate the methodology and evaluate the clinical value of surface mode on three- dimensional ultrasonography (3DUS) in static anatomical structures, 62 patients with various diseases were studied. The equipmen...To investigate the methodology and evaluate the clinical value of surface mode on three- dimensional ultrasonography (3DUS) in static anatomical structures, 62 patients with various diseases were studied. The equipment used here was Voluson 530D 3DUS imaging system and 3D volume trahsducer with frequency being 3. 0-5. 0 MHz. The 3DUS rendering method was surface mode. The results showed that: 1 ) Surface mode of 3DUS could demonstrate clearly the anatomical characteristics of the region-of-interest (ROI) and the inner wall of lesions or organs that contained fluid. The anatomic details, such as location, size, shape, and number of the ROI, could be visualized intuitively; 2) The outer anatomic features (e. g. contour, edge, configuration, etc. ) of some organs or lesions surrounded by fluid could be displayed clearly. It could be concluded that surface mode on 3DUS could provide more diagnostic information than two-dimensional ultrasonography (2DUS) in some cases and could served as a beneficial supplement to ZDUS in clinical practice.展开更多
Background Transperineal ultrasonography has been used as a diagnostic imaging modality for rectocele for many years.However,the consistency of ultrasonography and defecography in evaluating the severity of rectocele ...Background Transperineal ultrasonography has been used as a diagnostic imaging modality for rectocele for many years.However,the consistency of ultrasonography and defecography in evaluating the severity of rectocele was not satisfactory.This study aimed to evaluate the agreement in the measurement of rectocele parameters between the two methods in different positions and provide clinical implications for the diagnosis of rectocele.Methods In this pilot study,participants were recruited in an outpatient clinic of a tertiary hospital between December 2017 and December 2019.All participants separately underwent defecation proctography at sitting and squatting positions,and undertook transperineal ultrasonography at left lateral,sitting,and squatting positions.The consistency of ultrasonography and defecography was evaluated.Results Thirty female volunteers with rectocele were included in this study.The degree of anorectal angle was significantly larger at rest and during contraction,maximal Valsalva,and evacuation;the depth of the rectocele was significantly deeper during maximal Valsalva and evacuation;and the length of the perineumdescending was significantly longer during contraction and maximal Valsalva in using squatting position compared to the sitting position when performing the defecation proctography.The degree of anorectal angle,the depth of rectocele,the area of levator hiatus,and the volume of the rectocele were significantly different in using squatting,sitting,and left lateral positions when performing the transperineal ultrasonography.Bland-Altman semi-quantitative plots showed good consistency in the measurement of the anorectal angle and the depth of the rectocele between proctography and ultrasonography in both sitting and squatting positions.Conclusions The findings of our study may be considered as the preliminary evidence to support the use of transperineal ultrasonography with sitting and squatting positions as the imaging test of choice for evaluating patients with rectocele.展开更多
BACKGROUND Primary adenoid cystic carcinoma in the trachea(TACC)is a rare tumour.Tracheal bronchoscopy is always chosen as a routine approach to obtain a pathological diagnosis,but it can be associated with an increas...BACKGROUND Primary adenoid cystic carcinoma in the trachea(TACC)is a rare tumour.Tracheal bronchoscopy is always chosen as a routine approach to obtain a pathological diagnosis,but it can be associated with an increased risk of asphyxia.CASE SUMMARY We describe a case of TACC in a patient evaluated by chest computed tomography(CT)with three-dimensional reconstruction imaging and diagnosed by transoesophageal endoscopic ultrasonography.The pathological diagnosis confirmed tracheal adenoid cystic carcinoma.CONCLUSION We highlight the importance of CT and provide a successful exploration of transoesophageal biopsy as a safe alternative approach.展开更多
Fecal incontinence has a profound impact in a patient's life, impairing quality of life and carrying a substantial economic burden due to health costs. It is an underdiagnosed condition because many affected patie...Fecal incontinence has a profound impact in a patient's life, impairing quality of life and carrying a substantial economic burden due to health costs. It is an underdiagnosed condition because many affected patients are reluctant to report it and also clinicians are usually not alert to it. Patient evaluation with a detailed clinical history and examination is very important to indicate the type of injury that is present. Endoanal ultrasonography is currently the gold standard for sphincter evaluation in fecal incontinence and is a simple, well-tolerated and non-expensive technique. Most studies revealed 100%sensitivity in identifying sphincter defect. It is better than endoanal magnetic resonance imaging for internal anal sphincter defects, equivalent for the diagnosis of external anal sphincter defects, but with a lower capacity for assessment of atrophy of this sphincter.The most common cause of fecal incontinence is anal sphincter injury related to obstetric trauma. Only a small percentage of women are diagnosed with sphincter tears immediately after vaginal delivery, but endoanal ultrasonography shows that one third of these women have occult sphincter defects. Furthermore, in patients submitted to primary repair of these tears, ultrasound revealed a high frequency of persistent sphincter defects after surgery. Three-dimensional endoanal ultrasonography is currently largely used and accepted for sphincter evaluation in fecal incontinence, improving diagnostic accuracy and our knowledge of physiologic and pathological sphincters alterations. Conversely,there is currently no evidence to support the use of elastography in fecal incontinence evaluation.展开更多
Sonazoid(Daiichi Sankyo,Tokyo,Japan),a secondgeneration of a lipid-stabilized suspension of a perfluorobutane gas microbubble contrast agent,has been used clinically in patients with liver tumors and for harmonic gray...Sonazoid(Daiichi Sankyo,Tokyo,Japan),a secondgeneration of a lipid-stabilized suspension of a perfluorobutane gas microbubble contrast agent,has been used clinically in patients with liver tumors and for harmonic gray-scale ultrasonography(US)in Japan since January 2007.Sonazoid-enhanced US has two phases of contrast enhancement:vascular and late.In the late phase of Sonazoid-enhanced US,we scanned the whole liver using this modality at a low mechanical index(MI)without destroying the microbubbles, and this method allows detection of small viable hepatocellular carcinoma(HCC)lesions which cannot be detected by conventional US as perfusion defects in the late phase.Re-injection of Sonazoid into an HCC lesion which previously showed a perfusion defect in the late phase is useful for confirming blood flow intothe defects.High MI intermittent imaging at 2 frames per second in the late phase is also helpful in differentiation between necrosis and viable hypervascular HCC lesions.Sonazoid-enhanced US by the coded harmonic angio mode at a high MI not only allows clear observation of tumor vessels and tumor enhancement, but also permits automatic scanning with Sonazoidenhanced three dimensional(3D)US.Fusion images combining US with contrast-enhanced CT or contrastenhanced MRI have made it easy to detect typical or atypical HCC lesions.By these methods,Sonazoidenhanced US can characterize liver tumors,grade HCC lesions histologically,recognize HCC dedifferentiation, evaluate the efficacy of ablation therapy or transcatheter arterial embolization,and guide ablation therapy for unresectable HCC.This article reviews the current developments and applications of Sonazoid-enhanced US and Sonazoid-enhanced 3D US for diagnosing and treating hepatic lesions,especially HCC.展开更多
文摘AIM: To differentiate focal liver lesions based on enhancement patterns using three-dimensional ultrasonography (3D US) with perflubutane-based contrast agent.METHODS: Two hundred and eighty two patients with focal liver lesions,including 168 hepatocellular carcinomas (HCCs),63 metastases,40 hemangiomas and 11 focal nodular hyperplasias (FNHs),were examined by 3D US with perflubutane-based contrast agent.Tomographic ultrasound images and sonographic angiograms were reconstructed.Among 282 lesions,enhancement patterns of 163 lesions between January 2007 and October 2007 were analyzed retrospectively.Then from November 2007 to May 2008,compared with contrast-enhanced (CE) 2D US,CE 3D US was performed on 119 lesions for prospective differential diagnosis.Sensitivity,specificity,area under receiver operating characteristic curve (Az) and inter-reader agreement were assessed.RESULTS: With the tridimensional view,dominant enhancement patterns were revealed as diffuse enhancement or peripheral ring-like enhancement,followed with washout change for HCCs or metastases,respectively,and peripheral nodular enhancement or diffuse enhancement with spoke-wheel arteries,followed by persistent enhancement for hemangiomas or FNHs,respectively.At CE 3D US,the prospective differentiation of lesions showed sensitivity 92% (mean for two readers),specificity 91% and Az value 0.95 for HCCs,84%,97%,and 0.95 for metastases,91%,98%,and 0.98 for hemangiomas and 80%,99%,and 0.99 for FNHs,respectively,while good to excellent inter-reader agreement was achieved.No significant difference exists between prospective diagnosis accuracy at CE 3D US and that at CE 2D US.CONCLUSION: CE 3D US provides a spatial perspective for liver tumor enhancement,and could help in differentiating focal liver lesions.
基金supported by the Guanghua Innovation Medical Research Fund(No.0203116)
文摘Objective To quantitatively analyze the fetal lung echo and right lung volume in the third trimester by real-time three-dimensional ultrasound(3-D US)and evaluate the feasibility of fetal lung maturity.Methods A total of 732 women with normal singleton pregnancies between 28 and 42 weeks of gestation underwent ultrasound examination.The 3-D US equipment with a 3.5-5 MHz transabdominal transducer was used for the fetal biometric measurement.The echogenicity ratio between fetal lung and liver was compared.The fetal lung volume was calculated by the rotational multiplanar technique for volume measurement(VOCAL).Results The right fetal lung volume increased with the increase of gestational age with a linear positive correlation(r=0.884,P<0.01).After 34 weeks,the echogenicity ratio of fetal lung to liver was more than 1.1.Conclusion The echogenicity of lung/liver and fetal lung volume could be used as normal fetal predictable indicators for fetal lung maturity.
文摘BACKGROUND Lateral facial clefts are atypical with a low incidence in the facial cleft spectrum.With the development of ultrasonography(US)prenatal screening,such facial malformations can be detected and diagnosed prenatally rather than at birth.Although three-dimensional US(3DUS)can render the fetus'face via 3D reconstruction,the 3D images are displayed on two-dimensional screens without field depth,which impedes the understanding of untrained individuals.In contrast,a 3D-printed model of the fetus'face helps both parents and doctors develop a more comprehensive understanding of the facial malformation by creating more interactive aspects.Herein,we present an isolated lateral facial cleft case that was diagnosed via US combined with a 3D-printed model.CASE SUMMARY A 31-year-old G2P1 patient presented for routine prenatal screening at the 22nd wk of gestation.The coronal nostril-lip section of two-dimensional US(2DUS)demonstrated that the fetus'bilateral oral commissures were asymmetrical,and left oral commissure was abnormally wide.The left oblique-coronal section showed a cleft at the left oral commissure which extended to the left cheek.The results of 3DUS confirmed the cleft.Furthermore,we created a model of the fetal face using 3D printing technology,which clearly presented facial malformations.The fetus was diagnosed with a left lateral facial cleft,which was categorized as a No.7 facial cleft according to the Tessier facial cleft classification.The parents terminated the pregnancy at the 24th wk of gestation after parental counseling.CONCLUSION In the diagnostic course of the current case,in addition to the traditional application of 2D and 3DUS,we created a 3D-printed model of the fetus,which enhanced diagnostic evidence,benefited the education of junior doctors,improved parental counseling,and had the potential to guide surgical planning.
文摘To investigate the methodology and evaluate the clinical value of surface mode on three- dimensional ultrasonography (3DUS) in static anatomical structures, 62 patients with various diseases were studied. The equipment used here was Voluson 530D 3DUS imaging system and 3D volume trahsducer with frequency being 3. 0-5. 0 MHz. The 3DUS rendering method was surface mode. The results showed that: 1 ) Surface mode of 3DUS could demonstrate clearly the anatomical characteristics of the region-of-interest (ROI) and the inner wall of lesions or organs that contained fluid. The anatomic details, such as location, size, shape, and number of the ROI, could be visualized intuitively; 2) The outer anatomic features (e. g. contour, edge, configuration, etc. ) of some organs or lesions surrounded by fluid could be displayed clearly. It could be concluded that surface mode on 3DUS could provide more diagnostic information than two-dimensional ultrasonography (2DUS) in some cases and could served as a beneficial supplement to ZDUS in clinical practice.
基金funded by the National Natural Science Foundation of China[81603618,81603625]Shanghai Municipal Health Commission[2018BR19].
文摘Background Transperineal ultrasonography has been used as a diagnostic imaging modality for rectocele for many years.However,the consistency of ultrasonography and defecography in evaluating the severity of rectocele was not satisfactory.This study aimed to evaluate the agreement in the measurement of rectocele parameters between the two methods in different positions and provide clinical implications for the diagnosis of rectocele.Methods In this pilot study,participants were recruited in an outpatient clinic of a tertiary hospital between December 2017 and December 2019.All participants separately underwent defecation proctography at sitting and squatting positions,and undertook transperineal ultrasonography at left lateral,sitting,and squatting positions.The consistency of ultrasonography and defecography was evaluated.Results Thirty female volunteers with rectocele were included in this study.The degree of anorectal angle was significantly larger at rest and during contraction,maximal Valsalva,and evacuation;the depth of the rectocele was significantly deeper during maximal Valsalva and evacuation;and the length of the perineumdescending was significantly longer during contraction and maximal Valsalva in using squatting position compared to the sitting position when performing the defecation proctography.The degree of anorectal angle,the depth of rectocele,the area of levator hiatus,and the volume of the rectocele were significantly different in using squatting,sitting,and left lateral positions when performing the transperineal ultrasonography.Bland-Altman semi-quantitative plots showed good consistency in the measurement of the anorectal angle and the depth of the rectocele between proctography and ultrasonography in both sitting and squatting positions.Conclusions The findings of our study may be considered as the preliminary evidence to support the use of transperineal ultrasonography with sitting and squatting positions as the imaging test of choice for evaluating patients with rectocele.
文摘BACKGROUND Primary adenoid cystic carcinoma in the trachea(TACC)is a rare tumour.Tracheal bronchoscopy is always chosen as a routine approach to obtain a pathological diagnosis,but it can be associated with an increased risk of asphyxia.CASE SUMMARY We describe a case of TACC in a patient evaluated by chest computed tomography(CT)with three-dimensional reconstruction imaging and diagnosed by transoesophageal endoscopic ultrasonography.The pathological diagnosis confirmed tracheal adenoid cystic carcinoma.CONCLUSION We highlight the importance of CT and provide a successful exploration of transoesophageal biopsy as a safe alternative approach.
文摘Fecal incontinence has a profound impact in a patient's life, impairing quality of life and carrying a substantial economic burden due to health costs. It is an underdiagnosed condition because many affected patients are reluctant to report it and also clinicians are usually not alert to it. Patient evaluation with a detailed clinical history and examination is very important to indicate the type of injury that is present. Endoanal ultrasonography is currently the gold standard for sphincter evaluation in fecal incontinence and is a simple, well-tolerated and non-expensive technique. Most studies revealed 100%sensitivity in identifying sphincter defect. It is better than endoanal magnetic resonance imaging for internal anal sphincter defects, equivalent for the diagnosis of external anal sphincter defects, but with a lower capacity for assessment of atrophy of this sphincter.The most common cause of fecal incontinence is anal sphincter injury related to obstetric trauma. Only a small percentage of women are diagnosed with sphincter tears immediately after vaginal delivery, but endoanal ultrasonography shows that one third of these women have occult sphincter defects. Furthermore, in patients submitted to primary repair of these tears, ultrasound revealed a high frequency of persistent sphincter defects after surgery. Three-dimensional endoanal ultrasonography is currently largely used and accepted for sphincter evaluation in fecal incontinence, improving diagnostic accuracy and our knowledge of physiologic and pathological sphincters alterations. Conversely,there is currently no evidence to support the use of elastography in fecal incontinence evaluation.
文摘Sonazoid(Daiichi Sankyo,Tokyo,Japan),a secondgeneration of a lipid-stabilized suspension of a perfluorobutane gas microbubble contrast agent,has been used clinically in patients with liver tumors and for harmonic gray-scale ultrasonography(US)in Japan since January 2007.Sonazoid-enhanced US has two phases of contrast enhancement:vascular and late.In the late phase of Sonazoid-enhanced US,we scanned the whole liver using this modality at a low mechanical index(MI)without destroying the microbubbles, and this method allows detection of small viable hepatocellular carcinoma(HCC)lesions which cannot be detected by conventional US as perfusion defects in the late phase.Re-injection of Sonazoid into an HCC lesion which previously showed a perfusion defect in the late phase is useful for confirming blood flow intothe defects.High MI intermittent imaging at 2 frames per second in the late phase is also helpful in differentiation between necrosis and viable hypervascular HCC lesions.Sonazoid-enhanced US by the coded harmonic angio mode at a high MI not only allows clear observation of tumor vessels and tumor enhancement, but also permits automatic scanning with Sonazoidenhanced three dimensional(3D)US.Fusion images combining US with contrast-enhanced CT or contrastenhanced MRI have made it easy to detect typical or atypical HCC lesions.By these methods,Sonazoidenhanced US can characterize liver tumors,grade HCC lesions histologically,recognize HCC dedifferentiation, evaluate the efficacy of ablation therapy or transcatheter arterial embolization,and guide ablation therapy for unresectable HCC.This article reviews the current developments and applications of Sonazoid-enhanced US and Sonazoid-enhanced 3D US for diagnosing and treating hepatic lesions,especially HCC.
