Ultrasound Speckle Tracking Imaging Contributes to Early Diagnosis of Impaired Left Ventricular Systolic Function in Patients with Type 2 Diabetes Mellitus

To investigate the value of ultrasound speckle tracking imaging （STI） in the assessment of the short-axis and long-axis systolic function of the left ventricle （LV） in patients with type 2 diabetes mellitus （DM）, 100 subjects with normal ejection fraction were studied, including 41 patients with DM only （DM group）, 22 patients with both DM and left ventricular hypertrophy （DH group）, and 37 healthy subjects （control group）. Left ventricle systolic function in the long axis defined as longitudinal strain, and that in the short axis defined as radial strain, apical and basal LV rotations, and LV twist were assessed respectively. The results showed that average peak strain in the long axis at basal, middle and apical levels, and global peak strain were significantly decreased in the patient groups when compared with the control group （P〈0.001 for each）. The parameters in DH group were significantly lower than those in DM group （P〈0.01 for each）. There were no significant differences in average radial peak strain in the short axis at different levels, and global peak strain among the three groups （P〉0.05）. Apical and basal LV rotations, and LV twist were greater in the patient groups than in the control group （P〈0.01 for each）. Basal LV rotation and LV twist were greater in DH group than those in DM group （P〈0.01）. It was concluded that STI may be used to identify early abnormalities in patients with type 2 DM that have normal left ventricular systolic function.

Significance of ultrasound evaluation of carotid atherosclerotic plaque for diagnosing ischemic cerebrovascular disease

BACKGROUND： Carotid artery is the main source for craniocerebral blood supply. Its intimal plaque formation and arterial stenosis degree both are the risk factors for ischemic cerebrovascular disease.Therefore, the close relationship of carotid atherosclerotic plaque and ischemic cerebrovascular disease, and ultrasound evaluation of carotid atherosclerotic plaque have become the hot spot in studying ischemic cerebrovascular disease.OBJECTIVE： This study was to detect the degree of carotid atherosclerosis of ischemic cerebrovascular disease patients by ultrasonography, and to analyze the situation of carotid atherosclerosis and its relationship with clinic.DESIGN： Clinical randomized concurrent control experiment.SETTING： Lintong Convalescent Hospital of Lanzhou Military Area Command of Chinese PLA.PARTICIPANTS： Totally 60 outpatients and inpatients with ischemic cerebrovascular disease, 42 males and 18 females, admitted to Lintong Convalescent Hospital of Lanzhou Military Area Command of Chinese PLA between January 2006 and December 2006 were involved in the patient group. They met the diagnosis criteria of ischemic cerebrovascular disease constituted by the 4th Cerebrovascular Disease Conference in 1996, and were confirmed to suffer from ischemic cerebrovascular disease by skull CT and MRI. Another 20 subjects who received healthy examination concurrently in the same hospital, 12 males and 8 females, were involved in the control group. Informed consents of detected items were obtained from involved subjects.METHODS： The plaque thickness of mid portion, distal end and crotch of common carotid artery （CCA）,internal carotid artery （ICA）, external carotid artery （ECA） and vertebral artery （VA） of involved subjects,who received health examination was separately detected with color Doppler ultrasonograph （HDI-5000）.Then, total integral of plaque was calculated. The intima-media thickness （IMT） was measured with two-dimensional ultrasonography. The inner diameter stenosis degree of subjects who had plaque was measured. Blood flow parameters were recorded, and stenosis degree and plaque area were calculated. Blood flow volume of bilateral carotid artery and VA was separately measured with ultrasound equipment software,and brain blood flow volume was calculated.MAIN OUTCOME MEASURES： Atherosclerotic degree and blood flow volume of patients of two groups.RESULTS： Sixty patients with ischemic cerebrovascular disease and twenty subjects who received health examination participated in the final analysis. ①The IMT thickness, total plaque score, and total plaque area of patient group was significantly superior to that of control group, respectively（ t=5.216 - 10.158, P 〈 0.05 ）.② There were significant differences in the stenosis degree of CCA, ICA and VA between patient group and control group （t=6.720 - 12.816, P 〈 0.05 ） . ③ The blood flow volume of CCA, ICA, VA and brain of patient group was significantly lower than that of control group, respectively （t=2.872 - 10.860, P 〈 0.05）.CONCLUSION： Ischemic cerebrovascular disease patients have different degrees of changes in atherosclerosis and arterial blood flow.

Evaluation of cerebrovascular reactivity by ultrasonography in type 2 diabetic patients with hypertension

BACKGROUND： Cerebrovascular reactivity （CVR） reflects cerebrovascular reserve capacity, and cerebrovascular reactivity damage prognosticates a very high risk of stroke. OBJECTIVE： To evaluate CVR by detecting the increase rate of blood flow volume of middle cerebral artery （MCA） before and after breathholding in diabetic patients with hypertension, and observe the effects of hypertension on cerebrovascular reserve capacity of diabetic patients. DESIGN： Controlled observation. SETTINGS： Department of Function, Affiliated Hospital of Hebei University; Department of Special Diagnosis, the 202 Hospital of Chinese PLA. PARTICIPANTS： Inpatients or outpatients with type 2 diabetes mellitus （DM） or primary hypertension admitted to Departments of Gastroenterology and Cardiology, Affiliated Hospital of Hebei University and the 202 Hospital of Chinese PLA from April to December 2004 were involved in this experiment. Inclusive criteria： type 2 DM met the criteria of the report on diabetes diagnosis announced in 1999 by WHO expert committee, totally 88 patients were involved. Primary hypertension met the diagnosis criteria announced in 1999 by WHO/ISH, totally 42 patients were involved. Another group of 43 concurrent subjects who received physical examination served as controls. According to the disease condition, the involved patients were assigned into 3 groups： DM group （only diabetic patients）, hypertension group （only hypertension patients） and DM complicated with hypertension group （diabetic patients with hypertension）. Informed consent for the examination was obtained from all the involved subjects. METHODS： Before MCA of subjects was detected, bilateral carotid artery was routinely detected by high-frequency ultrasonography. Subjects were rejected when stenosis rate of unilateral internal carotid artery or common carotid artery ≥ 70%. Vessels were expanded with transcranial color Duplex Doppler by breath holding test for detecting vascular reactivity. Hypercapnia was created by BHT. The mean velocity and diameter of blood flow were detected under the quiescent condition and 25 s after breath holding with transcranial color-coded duplex sonography. The volume of blood flow of MCA was calculated according to the following formula： Volume of blood flow of MCA （mL/ min） = （the diameter of blood flow /2） 2×π× mean blood flow velocity×60. The increase rates of mean blood flow velocity and blood flow volume of patients with hypercapnia were calculated as compared with under the quiescent condition to evaluate cerebrovascular reactivity. MAIN OUTCOME MEASURES： Mean blood flow velocity, blood flow diameter and MCA blood flow volume as well as the increase rates of them. RESULTS： Among the 173 participates, 103 patients and 39 healthy controls were involved in the final analysis, and the other 31 dropped out due to not accomplishing the examination. ①Comparison of blood flow parameter of MCA under the quiescent condition： The mean blood flow velocity of DM complicated by hypertension group was significantly higher than that of DM group （P 〈 0.05） and control group （P 〈 0.05）; The blood flow diameter of DM complicated by hypertension group was significantly smaller than that of control group （P 〈 0.01）. Under the quiescent condition, significant difference was not found in the intergroup comparison of blood flow volume of MCA. ② Comparison of increase rate of blood flow parameter： In the DM group, hypertension group, DM complicated by hypertension group and control group, the increase rate of mean blood flow velocity of was （29.34±4.50）%,（29.35±4.35）%,（26.68±4.99）% and （30.99±3.54）%, respectively, the increase rate of blood flow volume of MCA was （35.32±5.08）%, （35.36±6.16）%,（31.78±7.11）% and（37.26±4.17）%, respectively, and the increase rate of blood flow diameter was （2.29±1.09）%,（2.27±0.95）%,（1.97±1.05）% and（2.36±0.46）%, respectively. The increase rate of mean blood flow velocity and that of blood flow volume of MCA in the DM complicated byhypertension group were significantly lower than those in the other 3 groups （P 〈 0.05）. CONCLUSION： CVR is markedly lowered and cerebrovascular reserve capacity is damaged in diabetic patients with hypertension.

Study on correlation between pathology and the contrast-enhanced ultrasound characteristics of primary liver cancer

Objective:The aim of this study was to evaluate the value of contrast-enhanced ultrasound(CEUS) for blood perfusion of primary liver cancer(PHC) and investigate the correlation between microvascular architecture of PHC and pathological differentiation.Methods:Two hundred and seventy-eight patients with 329 PHC lesions were examined by CEUS and analysised the contrast enhancement pattern and correlation with pathology.Results:1.CEUS patterns of PHC:71.7%(236/329) showed "swift enhancement in the arterial phase and swift expurgation in the portal phase",13.4%(44/329) for as "swift enhancement and slow expurgation",7.3%(24/329) as "swift enhancement and simultaneity expurgation",4.3%(14/329) for the "slow enhancement and swift expurgation",2.1%(7/329) as "slow enhancement and expurgation",1.2%(4/329) as "not fast forward".2.90.3%(297/329) of PHC lesions were hypervascular liver cancer and 9.7%(32/329) were hypovascular.Hepatocellular carcinoma(HCC) were hypervascular lesions and intrahepatic cholangiocarcinoma(ICC) were hypovascular lesions.3.PHC size had a significant difference on the contrast media purfusion pattern(P < 0.05),but not on the contrast media expurgation pattern.4.The accuracy of PHC by CEUS were 97.3% and compared to pathology,9 lesions of PHC were misdiagnosed.Conclusion:CEUS can show the different blood perfusion characteristics of PHC with closely related to pathological differentiation,which be valuable to diagnose liver cancer.