Ultrasonic elastography in clinical quantitative assessment of fatty liver.

AIM: To investigate the clinical application of ultrasonic elastography in quantitative assessment of fatty liver grading. METHODS: A total of 105 patients with fatty liver were divided into mild group (n = 46), moderate group (n = 39), and severe group (n = 20). Forty-five healthy individuals served as a normal control group. All patients who underwent routine ultrasound scan and further ultrasonic elastography were evaluated accordingly to the evaluation standards for ultrasonic elastography. The ratio of surface areas of blue region/total surface area in the desired region was measured. RESULTS: Ultrasonic elastography technique, in comparison to traditional ultrasound, had a rather high consistence in grading of fatty liver [κ value = (95.3%-63.6%)/(1%-63.6%) = 0.87, P = 0.001]. The score of ultrasonic elastography increased with the severity of fatty liver with a sensitivity of 97.14% and a specificity of 91.11%. A significant difference was found in the ratio of surface areas of blue regions between different groups (P < 0.05). CONCLUSION: Ultrasonic elastography can be used in quantitative assessment of the severity of fatty liver.

Overexpression of TrkB promotes the progression of colon cancer.

Studies have confirmed that TrkB plays important roles in facilitating metastasis in various types of malignant tumors. In the present study, 30 cases of colon cancer and matched non-tumors were examined for the expression of TrkB by Western blot. The expression of TrkB was also examined in 90 colon tumor sections by immunohistochemical methods, and D2-40 staining was used to evaluate the correlation between TrkB expression and lymphatic vessel density. To investigate the effects of TrkB on the progression of colon cancer, siRNA specific for TrkB was transfected into LoVo cells, and proliferation, apoptosis and invasion of transfected cells were examined using MTT [3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide], flow cytometry and Transwell assays, respectively. Our results showed that TrkB was up-regulated in colon tumors compared with the non-tumorous counterparts, and the overexpression of TrkB was closely correlated with lymphatic vessel density (LVD) and metastasis. Inhibition of TrkB by siRNA increased the apoptotic rates of transfected cells, while the numbers of proliferative and invasive cells were decreased. In summary, our data suggest that overexpression of TrkB in colon cancer possibly plays roles in inhibiting apoptosis, promoting proliferation and invasion, facilitating tumor progression by lymphangiogenesis-associated metastasis.

Nodules in the thickened greater omentum: a good indicator of lesions?

OBJECTIVE: In patients with unclear ascites, a thickened greater omentum with variable nodules is usually encountered with high-frequency insonation. The purpose of our study was to assess the importance of nodules in indicating the origin of ascites. METHODS: In patients suggested for a biopsy of the greater omentum, if nodules were found in the omentum, sonograms of the nodules were recorded, and during the biopsy, 2 passes were made for each procedure in the nodule and the thickest region without nodules, respectively. A biopsy was considered successful if a specific benign or malignant diagnosis was made. RESULTS: In the 258 patients undergoing sonographically guided biopsies of the greater omentum from November 2001 to November 2008, the percentage of definitive diagnoses was 94.57% (244 of 258), and sonography showed nodules in 62 patients. Nodules were found more often by a 10-MHz transducer (62 cases) than by a 3.5-MHz transducer (15 cases). The percentage of definitive diagnoses by sonographically guided biopsies was 100% (62 of 62) at the sites of the nodules and decreased to 87.1% (54 of 62) at the sites without nodules. According to the pathologic results, 48 cases were peritoneal carcinomatosis, and 14 cases were tuberculous peritonitis. The sensitivity and specificity of nodules for indicating malignant ascites were 77.42% and 75.27%, respectively. CONCLUSIONS: Nodules in the greater omentum were good indicators of lesions and were well shown by a high-frequency transducer. A biopsy at the site of a nodule could substantially increase the positive biopsy result rate.

Ultrasound-guided biopsy of greater omentum: an effective method to trace the origin of unclear ascites.

OBJECTIVES: Thickened greater omentum is encountered with high frequency in patients with ascites. The purpose of our study was to assess the utility of greater omentum biopsy under the guidance of ultrasound (US) in tracing the origin of unclear ascites and differentiating benign and malignant ascites. MATERIALS AND METHODS: We retrospectively reviewed our institutional database for all records of greater omentum biopsy cases. One hundred and ninety-four patients with unclear ascites and thickened greater omentum were included in the study. The sonograms of greater omentum were evaluated before undergoing the ultrasound-guided biopsy and a biopsy was considered successful if a specific benign or malignant diagnosis was rendered by the pathologist. RESULTS: Successful biopsy was rendered for 182 biopsy procedures (93.8%, 182/194) including tuberculosis (n=114), chronic inflammation (n=3), metastases (n=58), malignant mesothelioma (n=6) and pseudomyxoma peritonei (n=1). Twelve biopsies were non-diagnostic. According to the results of biopsy and follow-up, the sensitivity and specificity of biopsy in distinguishing malignant ascites from benign ascities were respectively 95.6% (65/68) and 92.9% (117/126). The greater omentum of 84 cases of tuberculous peritonitis showed "cerebral fissure" sign and was well seen as an omental cake infiltrated with irregular nodules when involved by carcinomatosis. No "cerebral fissure" sign was observed in peritoneal carcinomatosis. The sensitivity and specificity of this sign in indicating the existence of tuberculous peritonitis were 73.5% (89/121) and 100% (73/73). Moreover, if the specific "cerebral fissure" sign was combined with the biopsy results, the specificity of biopsy in distinguishing malignant ascites from benign ascits increased to 96.8% (122/126). CONCLUSION: Ultrasound-guided biopsy of greater omentum is an important and effective method to diagnose the unclear ascites for patients with thickened omentum if certain techniques could be paid attention to. "Cerebral fissure" sign of greater omentum was a specific sign in indicating the tuberculous peritonitis and could increase the specificity of biopsy in distinguishing malignant ascites from benign ascits if combined with the biopsy results.