胆囊作为贮存和浓缩胆汁的器官，其内的胆汁易于析出、凝集而形成结石。胆囊最常见的疾病多与结石相关，如胆石症、急慢性胆囊炎、胆囊癌等； 其他影响胆囊的病理状态还包括胆道动力障碍、术后改变等。超声对胆囊结石及胆囊炎的诊断有较高的敏感性及特异性，还可通过摄取高脂食物前后对比评价胆囊功能，是胆囊疾病的传统影像检查手段，但对肥胖患者其图像质量及解剖细节显示较差。目前，常规MRI已经成为重要的胆囊成像方法之一，并可引入经胆道排泄的造影剂进一步清晰显示其解剖及生理。对于超声不能很好评价的胆囊疾病患者应首选MRI检查。
Objective To investigate the value of a new double action MR contrast agent——Gd-BOPTA in the diagnosis of focal nodular hyperplasia (FNH) of the liver with correlation of pathology. Methods Dedicated MRI scans were performed for 5 patients suspected to have liver FNH on clinical and imaging basis (six lesions). The MR imaging protocol included axial T1W and T2W plain scan, coronal T2 weighted imaging, 3D MRCP, Gd-BOPTA enhanced LAVA dynamic tri-phasic acquisitions (scanning at 15 s, 55 s and 90 s respectively), enhanced 2D T1W scan, enhanced LAVA in delay phase (at 5 and 10 min) and in the hepatobiliary phase (at 40 and 80 min). The imaging features on each MR sequence were compared with surgical and pathological findings. Results Six lesions in 5 FNH patients were all correctly diagnosed (5 conformed by surgery and 1 by needle biopsy). ①The hemodynamic phase: The parenchyma of 5 lesions were markedly enhanced in the arterial phase, being isointense or slight hypointense in both the portal venous and delay phases, while 1 lesion was isointense in all phases except being slight hyperintense in the arterial phase; The central scar of 5 lesions were not enhanced in the dynamic phase, but showed delayed enhancement. ②The hepatobiliary (excretory) phase: The parenchyma of all 6 lesions were slight hyperintense or isointense, and tree-like bile ducts with hyperintensity were seen within one lesion. The scar showed no enhancement. ③Pathology: The parenchyma was consisted of disarranged normal hepatocytes but with cytoedema, lack of portal tracts and cholestatic change. The central scar showed rich fibrous tissue, a very thick-walled arteriole, proliferative bile ducts, infiltration of inflammatory cells and myxomatous changes. Conclusion As a dual-phase MR contrast agent capable of depicting both the hemodynamic attributes and hepatobiliary excretion, Gd-BOPTA enhanced MRI can reflect the pathological features of FNH and reach a high diagnostic accuracy.
Objective To investigate the value of contrast-enhanced ultrasonography in detection and diagnosis of small primary liver cancer. Methods SonoVue-enhanced ultrasonography were performed on 353 patients with 378 primary liver cancer, less than 3 cm in diameter. Enhancement patterns and enhancement phases of hepatic lesions on contrast-enhanced ultrasonography were analyzed and compared with the results of histopathology. Results In all hepatic tumors, 96.6% （365/378） lesions enhanced in the arterial phase. Among them, 317 (83.9%) tumors enhanced earlier than liver parenchyma and 48 (12.7%) tumors enhanced synchronously with liver parenchyma, and 342 (90.5%) tumors showed early wash-out in the portal and late phases. With regard to the enhancement pattern, 329 (87.0%) tumors presented whole-lesion enhancement, 35 (9.3%) to be mosaic enhancement and 14 (3.7%) to be rim-like enhancement. If taking the whole-lesion enhancement and mosaic enhancement in arterial phase as diagnotic standard for primary liver cancer on contrast-enhanced ultrasonography, the sensitivity was 92.9%(351/378), and if the earlier or synchronous enhancement of the tumor compared with liver parenchyma in arterial phase and the wash-out in portal phase were regarded as the stardand, the sensitivity was 87.3%(330/378). Conclusion Contrast-enhanced ultrasonography could display real-time enhancement patterns as well as the wash-out processes both in hepatic tumors and the liver parenchyma. It might be of clinical value in diagnosis of primary liver cancer based on the hemodynamics of hepatic tumors on contrast-enhanced ultrasonography.
ObjectiveTo evaluate the clinical application and the efficacy of contrast enhanced ultrasonography (CEUS)guided percutaneous radiofrequency ablation (RFA) in patients with liver metastases. MethodsTotal 136 patients with 219 liver metastatic tumors, which were detected by CEUS before RFA therapy, were analyzed retrospectively. The diamter of tumors was (3.2±1.2) cm. Among them, the largest tumor more than 3 cm in diameter were found in 48.5% (66 patients), and 57.4% (78 patients) were with solitary metastasis. Enhanced CT and (or) MRI, and laboratory tests were applied to evaluate the outcomes after RFA treatment by regular followup. ResultsTumors were not detected by conventional ultrasonography in two cases, and 47.0% (63/134) of the patients with the largest tumor were 0.3 cm larger by CEUS than by conventional ultrasonography. More 40 tumors were detected in 18.4% (25/136) patients by CEUS. Followup ranged from 3 to 68 months (median time of 12 months). Early tumor necrosis rate one month after therapy was 98.2% (215/219 tumors). The incidence of local recurrence, new intrahepatic metastasis, and extrahepatic metastasis was 16.9% (23/136), 38.2% (52/136), and 8.8% (12/136), respectively. Local recurrence and new intrahepatic metastasis happened 2-25 months (median time of 6 months) after treatment. Local recurrence rates of the largest tumors ≥ 3 cm and tumor lt; 3 cm was 22.7% and 11.4%， respectively (P=0.079). The rate of new intrahepatic metastasis for the solitary metastasis cases was significantly lower than that for multiple metastases cases (25.6% versus 55.2%, P=0.000). The 1, 2, 3year survival rates were 82.5%, 64.3%, and 50.1%, and the 1, 2, 3year local recurrence free survival rates were 67.7%, 53.8%, and 38.3%, respetively. Patients with solitary metastasis survived longer than that with multiple metastases (P=0.034). ConclusionPatients with liver metastases treated by CEUSguided percutaneous RFA can get better survival rate, and CEUS is of much value for clinic application.
Objective To observe the therapeutic effect of ultrasonic microbubble combined with bevacizumab (Avastin) on choroidal neovascularization induced by photocoagulation in rabbits.Methods CNV was induced by photocoagulation with argon laser in 30 rabbits (60 eyes).All of the rabbits underwent fundus fluorecein angiography (FFA) 21 days after photocoagulation; 6-8 hours later, 3 rabbits were randomly chosen to be executed to having the immunohistochemical examination.Twenty one days after photocoagulation, 27 rabbits were divided randomly into 3 groups: bevacizumb, ultrasonic microbubble + bevacizumb,and control group; each group has 9 rabbits (18 eyes).The rabbits in control group had no interference treatment; while the rats in bevacizumb and ultrasonic microbubble + bevacizumb group underwent injection with bevacizumb or ultrasonic microbubble + bevacizumb respectively.FFA was performed on all of the rabbits 7,14,and 28 days after photocoagulation to observe the inhibition of CNV; immunofluorecence and Western blot were used to detect the expression of VEGF in retina and choroid.Twentyeight days is the time point to determine the therapeutic efficacy. The expression of VEGF and the results of FFA were the sdandards of the judgement of therapeutic efficacy.Results Proliferaion of CNV to the retinal inner layer and the obvious leakage of fluoresein in the photocoagulation area indicated that the model of CNV was set up successfully. Twenty eight days after injection,obvious fluorescent leakage was found in the control group, and the average fluorescent leakage in bevacizumab group differed much from the control group（t=16.2952，Plt;0.05）; while the difference between ultrasonic microbubble + bevacizumb group and bevacizumab group was also significant (t=4.7955，Plt;0.05) . At the same time point, the expression of VEGF in bevacizumab group detected by immunofluorecent assay and Western blot differed much from the control group (t=7.0327，9.2596；Plt;0.05),and the difference of VEGF between ultrasonic microbubble + bevacizumb group and bevacizumab group was significant（t=2.9724,17.1937；Plt;0.05）. this experiment show that ultrasound combined bevacizumab intravitreal injection of the therapeutic effect of CNV superior to other groups(Plt;0.01).Conclusion Ultrasound microbubble combined with bevacizumab injection may improve the therapeutic effect on CNV by inhibiting the expression of VEGF.
Objective To investigate the value of new double-phasic MR contrast agent (gadobenate dimeglumine， Gd-BOPTA) in diagnosis of hepatocellular carcinoma (HCC) with correlation of pathology. Methods MRI scan was performed on 33 patients suspected of having focal liver lesions by CT or ultrasonography. The MRI scan protocol included routine axial T1WI and T2WI, coronal T2WI and 3D-MRCP, Gd-BOPTA enhanced 3D gradient-echo sequence of T1W (LAVA sequence) acquiring dynamic data at 15 s, 55 s and 90 s respectively, delayed LAVA acquisition at 5 min, 10 min, and at 40 min, 80 min respectively. Surgical specimen was collected for pathological analysis. Results Surgery confirmed the diagnosis of HCC in 21 patients with 27 lesions. The sensitivity, specificity and accuracy of MR imaging with combined phases (including hemodynamic phase and hepatobiliary phase) were 92.9%,93.3%, 92.9% respectively. ①In the hemodynamic phase: 22 lesions showed early enhancement in arterial phase, fast “washout” in portal venous phase, and hypointense in delayed phase. Four lesions showed slight enhancement, while 1 lesion showed no enhancement in all hemodynamic phases. ②In the hepatobiliary phase: 23 lesions showed homogeneous hypointensity compared to the enhanced liver background, but 4 lesions (3 well-differentiated and 1 moderately-differentiated) had patchy or dot-like slightly hyperintense areas scattered within the lesions. Pathologically cholestatic changes of tumor cells were observed and bile-containing small ducts were present. Conclusion Gd-BOPTA enhanced MRI can both depict the hemodynamic characteristics and reflect the absence of normal hepatocyte function in HCC lesions, thus contributing greatly to the diagnosis of HCC.
ObjectiveTo systematically review the efficacy of statins for contrast induced nephropathy (CIN) prevention in cardiac intervention surgery patients. MethodsWe electronically searched databases including PubMed, Web of Knowledge, The Cochrane Library (Issue 5, 2015), VIP, WanFang Data and CNKI to collect randomized controlled trials (RCTs) about statins for CIN prevention in cardiac intervention surgery patients from inception to May 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 25 RCTs involving 37 353 patients were included, among them, 3 794 were CIN patients. The results of meta-analysis indicated that: compared with the placebo/blank group, the incidence rate of CIN was decreased in the statins group with a significant difference (OR=0.68, 95%CI 0.63 to 0.73, P<0.000 01). ConclusionCurrent evidence shows statins can reduce incidence of CIN in cardiac intervention surgery patients. Due to limited quality and quantity of the included studies, the above conclusions need more high quality studies to verify.
Conventional transcatheter aortic valve replacement is normally recommended with transthoracic echocardiography, and contrast agent mediated fluoroscopy under anesthesia to guide a better implantation of the transcatheter valve. However, iodine-containing contrast agent possibly damages the patient’s kidney, and even induces the acute kidney injury. We reported a 75-year-old patient diagnosed with severe aortic valve stenosis, moderate regurgitation, and chronic renal failure. We performed the aortic valve replacement under the guidance of fluoroscopy and transesophageal ultrasound without contrast agent. Seven days after surgery, the patient recovered well and discharged with alleviated aortic stenosis and fixed transcatheter aortic valve.
Objective To discuss feasibility and effectivity of intraoperative ultrasound (US) during endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm. Methods A radiographic contrast nephropathy patient of abdominal aortic aneurysm and left internal iliac artery aneurysm was treated by EVAR without iodine contrast media assisted by US. Then summarized the data of this patient. Results The precise placement of the stent-graft was performed for abdominal aortic aneurysm. The left internal iliac artery aneurysm was successfully treatment with the stent-graft and coils. Intraoperative Ⅱ type endoleak from inferior mesenteric artery and Ⅰ b type endoleak from right iliac stent were identified by using US. The operative duration was 120 min and the blood loss was only 20 mL. Ⅱ type endoleak was still detected and the Ⅰ b type of endoleak was loss on postoperative a week. Conclusion Intraoperative US-assisted EVAR in patients with infrarenal abdominal aortic aneurysm represents a new option for intraoperative visualization of aortoiliac segments required as proximal or distal fixation zones and identification of endoleaks, especially in those patients with contraindications for usage of iodine-containing contrast agents.
Objective To observe the protective effect of ultrasound microbubble contrast agentmediated transfection of brain-derived neurotrophic factor(BDNF) into the retina and visual cortex on retinal ganglion cells (RGC) after optic nerve injury. Methods A total of 88 male Sprague-Dawley (SD) rats were randomly divided into normal group (group A, eight rats), sham operation group (group B, 16 rats), control group (group C, 16 rats), eyes transfection group (group D, 16 rats), brain transfection group (group E, 16 rats), combined transfection group (group F, 16 rats). The optic nerve crush injury was induced, and then the groups B to F were divided into one-week and two-week after optic nerve injury subgroup with eight rats each, respectively. The rats in group B and C underwent intravitreal and visual cortex injection with phosphate buffered solution respectively. The rats in group D and E underwent intravitreal and visual cortex injection with the mixture solution of microbubbles and BDNF plasmids respectively. The rats in group F underwent both intravitreal and visual cortex injection with the mixture solution of microbubbles and BDNF plasmids at the same time. The ultrasound exposure was performed on the rats in group D to F after injection with the mixture solution of microbubbles and BDNF plasmids. One and two weeks after optic nerve injury, RGC were retrogradely labeled with Fluorogold; active caspase-3 protein was observed by immunohistochemistry and the N95 amplitude was detected by pattern electroretinogram (PERG). Results Golden fluorescence can be observed exactly in labeled RGC in all groups，the difference of the number of RGC between the six groups and ten subgroups were significant（F=256.30，65.18；P＜0.01）. Active caspase-3 in ganglion cell layer was detected in group C to F, but not in group A and B. The difference of the N95 amplitude between the six groups and ten subgroups were significant（F=121.56，82.38；P＜0.01）.Conclusion Ultrasound microbubble contrast agent-mediated BDNF transfection to the rat retina and visual cortex can inhibit the RGC apoptosis after optic nerve injury and protect the visual function.