ABSTRACT
Objective:To investigate the application value of contrast-enhanced ultra-sound, enhanced computed tomography (CT) and enhanced magnetic resonance imaging (MRI) in the diagnosis of small hepatocellular carcinoma.Methods:The clinical diagnositic trial was con-ducted. The clinicopathological data of 145 patients with small hepatocellular carcinoma who were admitted to the First Affiliated Hospital of Amy Medical University from January 2019 to June 2021 were collected. There were 121 males and 24 females, aged from 26 to 78 years, with a median age of 54 years. All patients were examined with contrast-enhanced ultrasound, enhanced CT and enhanced MRI, and underwent surgical resection of liver lesions within one month. Observation indicators: (1) postoperative histopathological examinations of patients with small hepatocellular carcinoma; (2) examination of small hepatocellular carcinoma by contrast-enhanced ultrasound, enhanced CT and enhanced MRI; (3) imaging features of small hepatocellular carcinoma in the contrast-enhanced ultrasound, enhanced CT and enhanced MRI; (4) enhancement mode distribution of small hepatocellular carcinoma in the arterial, portal and delayed phases of contrast-enhanced ultrasound, enhanced CT and enhanced MRI; (5) the efficacy of contrast-enhanced ultrasound, enhanced CT and enhanced MRI in the diagnosis of small hepatocellular carcinoma. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the Cochran′s Q test or the chi-square test. The sensitivity, specificity and accuracy were used to analyze the efficacy of contrast-enhanced ultrasound, enhanced CT and enhanced MRI in the diagnosis of small hepatocellular carcinoma. Results:(1) Postoperative histopathological examinations of patients with small hepatocellular carcinoma. There were 154 lesions detected in the postoperative histopathological examinations for the 145 small hepatocellular carcinoma patients, with the tumor diameter as (2.2±0.6)cm. (2) Examination of small hepatocellular carcinoma by contrast-enhanced ultrasound, enhanced CT and enhanced MRI. There were 153, 154 and 154 lesions detected in contrast-enhanced ultrasound, enhanced CT and enhanced MRI for the 145 patients with small hepatocellular carcinoma, respectively, with the detection rate as 99.35%(153/154), 100.00%(154/154) and 100.00%(154/154), showing no significant difference among the 3 imaging examination methods ( Q=2.00, P>0.05). (3) Imaging features of small hepatocellular carcinoma in the contrast-enhanced ultrasound, enhanced CT and enhanced MRI. Of the 153 lesions reported in contrast-enhanced ultrasound for patients with small hepatocellular carcinoma, 140 lesions showed "fast-in and fast-out" enhancement, 12 lesions showed "fast-in and slow-out" enhancement and 1 lesion showed isoenhancement in arterial phases and hypoenhancement in portal and delayed phase. Of the 154 lesions reported in enhanced CT for patients with small hepatocellular carcinoma, 112 lesions showed "fast-in and fast-out" enhancement, 13 lesions showed "fast-in and slow-out" enhancement, 14 lesions showed isoenhancement in arterial phase and hypoenhancement in portal and delayed phases, 5 lesions showed rim-like hyperenhancement in arterial phase and hypoenhancement in portal and delayed phases, 5 lesions showed hypoenhancement in the three phases, 3 lesions showed hyperenhancement in the three phases, 1 lesion showed isoenhancement in the three phases and 1 lesion showed isoenhancement in arterial and portal phases and hypoenhancement in delayed phase. Of the 154 lesions reported in enhanced MRI for patients with small hepatocellular carcinoma, 134 lesions showed "fast-in and fast-out" enhancement, 1 lesion showed "fast-in and slow-out" enhancement, 8 lesions showed isoenhancement in arterial phase and hypoenhance-ment in portal and delayed phases, 5 lesions showed rim-like hyperenhancement in arterial phase and hypoenhancement in portal and delay phases, 2 lesions showed rim-like hyperenhancement in the three phases, 1 lesion showed hyperenhancement in the three phases, 1 lesion showed hypoenhancement in the three phases, 1 lesion showed isoenhancement in arterial and portal phases and hypoenhancement in delayed late phase, 1 lesion showed edge delay enhancement in the three phases. (4) Enhancement mode distribution of small hepatocellular carcinoma in the arterial, portal and delayed phases of contrast-enhanced ultrasound, enhanced CT and enhanced MRI. Of the 153 lesions reported in contrast-enhanced ultrasound for patients with small hepatocellular carcinoma, there were 152 lesions with hyperenhancement and 1 lesion with iso or hypoenhance-ment in the arterial phase, there were 55 lesions with hyper or isoenhancement and 98 lesions with hypoenhancement in the portal venous phase, there were 12 lesions with hyper or isoenhancement and 141 lesions with hypoenhancement in the delayed phase. Of the 154 lesions reported in enhanced CT for patients with small hepatocellular carcinoma, there were 133 lesions with hyperen-hancement signal and 21 lesions with iso or hypoenhancement in the arterial phase, there were 53 lesions with hyper or isoenhancement and 101 lesions with hypoenhancement in the portal phase, there were 17 lesions with hyper or isoenhancement and 137 lesions with hypoenhancement in the delayed phase. Of the 154 lesions reported in enhanced MRI for patients with small hepatocellular carcinoma, there were 143 lesions with hyperenhancement and 11 lesions with iso or hypoenhance-ment in the arterial phase, there were 29 lesions with hyper or isoenhancement and 125 lesions with hypoenhancement in the portal phase, there were 5 lesions with hyper or isoenhancement and 149 lesions with hypoenhancement in the delayed phase. There were significant differences in the enhancement mode distribution of lesions in the arterial, portal and delayed phases among contrast-enhanced ultrasound, enhanced CT and enhanced MRI ( χ2=19.47, 13.21, 6.92, P<0.05). (5) The efficacy of contrast-enhanced ultrasound, enhanced CT and enhanced MRI in the diagnosis of small hepatocellular carcinoma. Of the 153 lesions reported in contrast-enhanced ultrasound for patients with small hepatocellular carcinoma, there were 3 lesions misdiagnosed according to the postoperative histopathological examinations. Of the 154 lesions reported in enhanced CT and enhanced MRI for patients with small hepatocellular carcinoma, there were 7 lesions and 2 lesions misdiagnosed according to the postoperative histopathological examinations, respectively. Lesions misdiagnosed in one imaging examination method were correctly diagnosed in the other two imaging examination methods. The sensitivity, specificity, accuracy were 97.4%, 63.0%, 92.3% for contrast-enhanced ultrasound in the diagnosis of small hepatocellular carcinoma. The above indica-tors were 95.5%, 63.0%, 90.6% for enhanced CT and 98.7%, 63.0%, 93.4% for enhanced MRI in the diagnosis of small hepatocellular carcinoma. There was no significant difference in the sensitivity and accuracy among the 3 imaging examination methods ( Q=2.92, 0.00, 1.81, P>0.05). Conclusion:Contrast-enhanced ultrasound, enhanced CT and enhanced MRI all have good diagnostic value in diagnosis of small hepatocellular carcinoma, and they complement each other.
ABSTRACT
OBJECTIVE@#To evaluate the effects of different postoperative analgesic strategies on neurocognitive function and quality of recovery in elderly patients at 7 days after thoracic surgery with one lung ventilation.@*METHODS@#Ninety elderly patients undergoing video-assisted thoracic surgery were randomized into 3 groups (@*RESULTS@#The patients in TA and EA groups had significantly higher MMSE scores and lower incidence of postoperative neurocognitive dysfunction (PNCD) than those in GA group without significant difference between the former two groups. At 7 days after the surgery, serum levels of S100-β and MMP-9 were significantly higher in GA group than in TA and EA group, and did not differ significantly between the latter two groups. QoR-40 scores were significantly higher in TA and EA groups than in GA group, and were higher in TA group than in EA group. The chest intubation time and length of hospital stay were significantly shorter in TA and EA groups than in GA group.@*CONCLUSIONS@#In elderly patients undergoing surgeries with one lung ventilation, general anesthesia combined with either postoperative continuous thoracic paravertebral block or epidural analgesia can significantly improve postoperative neurocognitive function and quality of recovery, but continuous thoracic paravertebral block analgesia can be more advantageous for improving postoperative quality of recovery.
Subject(s)
Aged , Humans , Analgesia, Epidural , Analgesics , Nerve Block , One-Lung Ventilation , Pain, PostoperativeABSTRACT
Objective:To investigate the clinical value of contrast-enhanced ultrasound and gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA MRI) in the diagnosis of hepatocellular carcinoma (HCC).Methods:The clinically diagnostic test was conducted. The clinicopathological data of 274 lesions in 250 patients with liver neoplasms who were admitted to the First Hospital Affiliated to Army Medical University from January 2017 to December 2018 were collected. There were 204 males and 46 females, aged (52±11)years, with a range from 22 to 78 years. Patients underwent contrast-enhanced ultrasound and Gd-EOB-DTPA MRI, and they received surgical resection or biopsy within one month. Images was read and analyzed by two senior radiologists for diagnosis. Observation indicators: (1) imaging features of contrast-enhanced ultrasound and Gd-EOB-DTPA MRI, including ① imaging features of contrast-enhanced ultrasound, ② imaging features of Gd-EOB-DTPA MRI, ③ enhanced imaging manifestation in different phases of 223 HCC lesions; (2) dignostic performance of contrast-enhanced ultrasound, Gd-EOB-DTPA MRI, or the combined examinations for HCC diagnosis, including ① sensitivity, specificity and accuracy rate of the three methods for HCC diagnosis and ② sensitivity, specificity and accuracy rate of the three methods for HCC diagnosis in lesions with different diameters. Count data were represented as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. With the pathological examination as the golden criteria of diagnosis, the sensitivity, specificity and accuracy rate of the contrast-enhanced ultrasound, Gd-EOB-DTPA MRI, or the combined examinations for HCC diagnosis were calculated.Results:(1) Imaging features of contrast-enhanced ultrasound and Gd-EOB-DTPA MRI. ① Imaging features of contrast-enhanced ultrasound: of the 223 HCC lesions on contrast-enhanced ultrasound, 167 lesions were accorded with fast in fast out of HCC, 7 were missed diagnosed and 49 were misdiagnosed. Of the 51 non-HCC lesions on contrast-enhanced ultrasound, 7 lesions were accorded with fast in fast out, including 3 of combined hepatocellular-cholangiocarcinoma, 2 of intrahepatic cholangiocarcinoma, 1 of neuroendocrine tumor, 1 of inflammatory granuloma, 44 lesions were no fast in fast out. ② Imaging features of Gd-EOB-DTPA MRI: of the 223 HCC lesions on Gd-EOB-DTPA MRI, 178 lesions were accorded with fast in fast out of HCC, 1 was missed diagnosed and 44 were misdiagnosed. Of the 51 non-HCC lesions on Gd-EOB-DTPA MRI, 5 lesions were accorded with fast in fast out, inlcuding 2 of intrahepatic cholangiocarcinoma, 1 of combined hepatocellular-cholangiocarcinoma, 1 of neuroendocrine tumor, 1 of inflammatory granuloma, 46 lesions were no fast in fast out. ③ Enhanced imaging manifestation in different phases of 223 HCC lesions. In arterial phase, 92.83%(207/223) of the lesions displayed hyper-enhanced on contrast-enhanced ultrasound, and 80.72%(180/223) of the lesions displayed hyper-enhanced on Gd-EOB-DTPA MRI, showing a significant difference ( χ2=14.240, P<0.05). In portal vein phase or late phase, 78.48%(175/223) of the lesions displayed hypo-enhanced on contrast-enhanced ultrasound, and 96.41%(215/223) of the lesions displayed hypo-enhanced on Gd-EOB-DTPA MRI, showing a significant difference ( χ2=32.674, P<0.05). On Gd-EOB-DTPA MRI, 96.41%(215/223) of the lesions displayed low signals in portal-vein phase or late phase, and 98.21%(219/223) of the lesions displayed low signals in hepatobiliary phase, showing no significant difference ( χ2=1.370, P>0.05). (2) Dignostic performance of contrast-enhanced ultrasound, Gd-EOB-DTPA MRI, or the combined examinations for HCC diagnosis. ① Sensitivity, specificity and accuracy rate of the three methods for HCC diagnosis: the sensitivities of contrast-enhanced ultrasound, Gd-EOB-DTPA MRI, or the combined examinations for HCC diagnosis were 74.89%(167/223), 79.82%(178/223), 94.62%(211/223), respectively. The specificities of contrast-enhanced ultrasound, Gd-EOB-DTPA MRI, or the combined examinations for HCC diagnosis were 86.27%(44/51), 90.20%(46/51), 80.39%(41/51). The accuracy rates of contrast-enhanced ultrasound, Gd-EOB-DTPA MRI, or the combined examinations for HCC diagnosis were 77.01%(211/274), 81.75%(224/274), 91.97%(252/274). There were significant differences in the sensitivity and accuracy rate among the three methods ( χ2=33.499, 23.345, P<0.05). There was no significant difference in the specificity among the three methods ( χ2=2.017, P>0.05). ② Sensitivity, specificity and accuracy rate of the three methods for HCC diagnosis in lesions with different diameters: 128 of 274 lesions had the maximun diameter>3 cm and ≤5 cm, 92 lesions had the maximun diameter >2 cm and ≤3 cm, 54 lesions had the maximun diameter≤ 2 cm. The sensitivities of contrast-enhanced ultrasound for HCC diagnosis in lesions with the maximun diameter>3 cm and ≤5 cm, >2 cm and ≤3 cm, ≤2 cm were 81.19%(82/101), 76.92%(60/78), 56.82%(25/44), the specificities were 92.59%(25/27), 71.43%(10/14), 90.00%(9/10), and the accuracy rates were 83.59%(107/128), 76.09%(70/92), 62.96%(34/54), respectively. The sensitivities of Gd-EOB-DTPA MRI for HCC diagnosis in lesions with the maximun diameter>3 cm and ≤5 cm, >2 cm and ≤3 cm, ≤2 cm were 83.17%(84/101), 79.49%(62/78), 72.73%(32/44), the specificities were 96.30%(26/27), 85.71%(12/14), 80.00%(8/10), and the accuracy rates were 85.94%(110/128), 80.43%(74/92), 74.07%(40/54), respectively. The sensitivities of contrast-enhanced ultrasound combined with Gd-EOB-DTPA MRI for HCC diagnosis in lesions with the maximun diameter>3 cm and ≤5 cm, >2 cm and ≤3 cm, ≤2 cm were 95.05%(96/101), 96.15%(75/78), 90.91%(40/44), the specificities were 92.59%(25/27), 57.14%(8/14), 80.00%(8/10), and the accuracy rates were 94.53%(121/128), 90.22%(83/92), 88.89%(48/54), respectively. There were significant differences in the sensitivities for HCC diagnosis in lesions with the maximun diameter>3 cm and ≤5 cm, >2 cm and ≤3 cm, ≤2 cm among the three methods ( χ2=9.703, 12.777, 13.142, P<0.05). There were also significant differences in the accuracy rates ( χ2=8.051, 6.600, 9.826, P<0.05). There was no significant difference in the specificies ( P>0.05). Conclusions:There was no significant difference in the dignostic performance for HCC diagnosis between contrast-enhanced ultrasound and Gd-EOB-DTPA MRI, and the combination of contrast-enhanced ultrasound and Gd-EOB-DTPA MRI can improve the diagnostic sensitivity and accuracy rate of HCC.
ABSTRACT
Objective To comparatively analyze the image characteristic of contrast-enhanced ultrasound(CEUS)and contrast-enhanced computed tomography(CECT),and explore the diagnostic value of the two methods in benign and malignant lesions of gallbladder.Methods comparative analysis the image characteristic of CEUS and CECT,the preoperative diagnostic results of 86 cases of gallbladder diseases were confirmed by pathology.Results The enhancement patterns of CEUS and CECT in benign and malignant lesions of gallbladder are similar.The sensitivity,specificity and accuracy of CEUS were 77.9%(53/68),77.8%(14/18),77.9%(67/86),respectively.The sensitivity,specificity and accuracy of CECT were 75%(51/68),55.6%(10/18),70.9%(61/86),respectively.The sensitivity,specificity and accuracy of the combination of CEUS and CECT were 83.8%(57/68),55.6%(10/18),77.9%(67/86),respectively.The accuracy of the combination of CEUS and CECT was higher than that of CECT in the diagnosis of malignant gallbladder lesions [(53.9±10.00)s vs(35.50±6.72)s],the differences were statistically significant(t=6.729,P＜0.001).Conclusions The enhancement patterns of CEUS and CECT in benign and malignant gallbladder lesions are similar.The combination of CEUS and CECT is helpful for improving the diagnostic accuracy of malignant gallbladder lesions.CEUS and CECT could corroborate and complement each other,and provide more valuable information for the differential diagnosis of benign and malignant gallbladder lesions.
ABSTRACT
Objective To investigate the application value of contrast-enhanced transrectal ultrasound (CE-TRUS) in differential diagnosis of prostate benign and malignant lesions. Methods A retrospective analysis of patients with prostate lesions detected by CE-TRUS from January 2014 to December 2016 in Southwest Hospital of Third Military Medical University was performed. Seventy-two cases of prostate disease with 88 lesions were confirmed by transrectal prostate biopsy under ultrasound guidance. The age of patients with benign and malignant lesions, serum prostate specific antigen (PSA), and the size of prostate and prostate inner gland were compared by independent sample t test. Pathologic results of transrectal prostate biopsy under ultrasound guidance were used as diagnostic gold standard, and the sensitivity, specificity and accuracy of CE-TRUS in diagnosis of benign and malignant prostate lesions were calculated. Results Sixty- seven lesions in 52 patients were benign prostatic diseases, and 21 lesions in 20 patients were prostate cancer in this study. The size of prostate and prostate inner gland were not different between patients with prostate cancer and benign prostatic diseases [(58.33±34.99) cm3vs (57.14±24.42) cm3, t=0.185, P=0.854; (34.98±19.96) cm3vs (33.89±17.65) cm3, t=0.213, P=0.832]. Most of prostate cancer lesions were in prostate outer gland area (15/21), and contrast-enhanced ultrasound imaging showed contrast enhancement increased mostly in arterial phase and faded faster than the surrounding tissues (16/21). However, most of prostate benign lesions were in prostate inner gland (47/67), and contrast-enhanced ultrasound imaging showed contrast enhancement was mostly equal with the surrounding tissue in arterial phase and faded the same as the surrounding tissues in venous phase (47/67). Pathologic results of transrectal prostate biopsy under ultrasound guidance were used as diagnostic gold standard, the sensitivity of CE-TRUS in diagnosis of benign and malignant prostate lesions was 85.71%, the specificity was 91.04%, and the accuracy was 89.77%. Two lesions were in prostate inner and outer gland border areas in the three missed prostate cancer lesions, and Gleason scores were all medium and high differentiated group. Six prostate benign lesions were diagnosed as malignant lesions, five lesions were confirmed prostate hyperplasia with chronic prostatitis and one was confirmed granulomatous inflammation with coagulation necrosis by transrectal prostate biopsy under ultrasound guidance. Conclusion CE-TRUS can effectively identify prostate benign and malignant lesions, and provides reliable information for accurate diagnosis of prostate cancer.
ABSTRACT
Objective To analyze the clinical characteristics and enhancement pattern on contrast-enhanced ultrasound (CEUS) of combined hepatocellular-cholangiocarcinoma (cHCC-CC).Methods A total of 49 patients who were pathologically confirmed as cHCC-CC by surgery and underwent CEUS examination in Southwest Hospital Affiliated to Third Military Medical University from January 2005 to February 2015 were retrospectively enrolled.There were 3 enhancement patterns on CEUS:hepatocellular carcinoma (HCC) pattern,cholangiocarcinoma (CC) pattern and indeterminate pattern.The proportions of HCC pattern and CC pattern of cHCC-CC were compared by x2 test.And the proportions of tumour maker elevation [(alpha-fetoproteins,AFP) and/or (carbohydrate antigen,CA19-9)] in accordance or discordance with enhancement patterns were compared by x2 test.Results Among the 49 cHCC-CC patients,44 were male and 5 were female.Mean age was (52.3 ± 9.8) years old (range:28-74 years old).Of all cases,41 (83.7％,41/49) patients had single nodule.Mean size of nodule was (5.3 ± 3.5) cm (range:1.5-13.8 cm),and the size of 51.0％ (25/49) lesions were ＜ 5 cm.Totally 34 (69.4％,34/49) patients had pathologically diagnosed cirrhosis.AFP elevation was found in 31 (63.3％,31/49) patients,CA19-9 elevation was found in 12 (24.5％,12/49) patients,simultaneous elevation of both AFP and CA19-9 was found in 9 (18.4％,9/49) patients.The percentages of CC pattern and HCC pattern were 51.0％ (25/49) and 44.9％ (22/49) respectively.And there was no significant difference between the two patterns (x2=0.368,P=0.544).In 9 patients with simultaneous elevation of both AFP and CA19-9,CC pattern was observed in 5 patients and HCC pattern was noted in 4 patients.There were 12 (24.5％,12/49) patients with tumor marker elevation (AFP or CA19-9) in discordance with enhancement patterns on CEUS.Among the 12 cases,9 cases with AFP elevation were CC patterns on CEUS and 3 cases with CA19-9 elevation were HCC patterns on CEUS.Simultaneous elevation of tumor makers (AFP and CA19-9) or tumor mark elevation (AFP or CA19-9) in discordance with enhancement patterns on CEUS was found in 21 (42.9％,21/49) patients,which was significantly more than simultaneous elevation of AFP and CA19-9 alone (18.4％,9/49) (x2=6.918,P=0.009).Conclusions Clinical characteristics of patients with cHCC-CC were similar to that of patients with HCC.The proportion of HCC pattern and CC pattern was comparable.Combination of test of tumor makers (AFP and CA19-9) and enhancement pattern on CEUS maybe helpful for the diagnosis of cHCC-CC.
ABSTRACT
Objective To compare the diagnostic ability of gadolinium diethylene-triamine-pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA MRI) and contrast-enhanced ultrasound (CEUS) for the diagnosis of hepatocellular carcinoma (HCC) ≤ 3 cm in diameter in patients with hepatic cirrhosis or chronic hepatitis B.Methods Ninty-two cases with single focal liver lesion ≤ 3 cm who underwent CEUS and Gd-EOB-DTPA MRI in Southwest Hospital Affiliated to Third Military Medical University were enrolled in the study.And all cases were diagnosed with hepatic cirrhosis or chronic hepatitis B.Pathology was the golden standard and all cases were diagnosed pathologically by surgical operation.Sensitivity,specificity,positive predictive value,negative predictive value and accuracy rate of the diagnosis of small HCC by CEUS,Gd-EOB-DTPA MRI and CEUS combined with Gd-EOB-DTPA MRI were calculated and compared with x2 test or Fisher exact probability.Results Of the 92 cases,82 cases were diagnosed as HCC and the other 10 cases were diagnosed as non-HCC.The sensitivity and the specificity for the diagnosis of HCC was 79.2％ (65/82) and 70.0％ (7/10) of CEUS alone and was comparable with that of Gd-EOB-DTPA MRI [74.4％ (61/82) vs 70.0％ (7/10)] alone (x2=0.548,P=0.459;P=1.000).When both CEUS and Gd-EOB-DTPA MRI met the diagnostic criteria for HCC,the sensitivity was lower [61.0％ (60/82),P=0.010] than that of CEUS alone,and the specificity [80.0％ (8/10),P=1.000] was not statistically different from that of CEUS alone.When CEUS or Gd-EOB-DTPA MRI met the diagnostic criteria for HCC,the sensitivity [92.7％ (76/82)] was higher than that of CEUS alone (x2=6.119,P=0.013) or Gd-EOB-DTPA MRI alone (x2=9.972,P=0.002),and the specificity [60.0％ (6/10)] was not statistically different from that of CEUS alone (P=1.000) or by Gd-EOB-DTPA MRI alone (P=1.000).Conclusions In patients with cirrhosis or chronic hepatitis B,the diagnostic ability of HCC ≤ 3cm in diameter by CEUS alone was comparable to that by Gd-EOB-DTPA MRI alone.Combination of CEUS and Gd-EOB-DTPA MRI may increase the sensitivity for the diagnosis of HCC,but the specificity not statistically improved.
ABSTRACT
ObjectiveTo investigate the relationship between liver stiffness and hepatocellular carcinoma (HCC) risk in chronic heptatitis B patients with negative α-fetoprotein (AFP) tests. MethodsFrom September 2012 to August 2014, this study enrolled a total of 82 HBV-relative native HCC patients as the case group. During the same period, a total of 253 chronic hepatitis B patients were also include in this study as the control group. These 253 patients were followed up for six months. All of the two groups were AFP-negative. Liver stiffness was measured in all patients by transient elastography device Fibroscan?. Logistic regression was applied to assess the risk of HCC incidence, and stratum-specific likelihood ratios (SSLR) was calculated.ResultsThe age, liver stiffness measurements and plasma albumin of patients in case group were 53 years old (44-61), 12.00 kPa (7.50-20.75), 43.14 g/L (39.50-46.75) respectively. The age, liver stiffness measurements and plasma albumin of patients in control group were 45 years old (38-56), 8.40 kPa (5.40-13.50), 46.40 g/L (43.75-48.50) respectively. The variables were compared between two groups with unpaired studentt test, and the results were statistically significant (t=4.33, 3.56, -4.48,P=0.00, 0.00, 0.00). The patients in case group were older, and had higher liver stiffness measurements and lower plasma albumin than that of the patients in control group. Logistic regression analysis showed that HCC incidence was associated with age,male-gender and liver stiffness, and the odds ratios (OR) was 1.053, 2.432, 6.803 respectively. When liver stiffness was25 kPa, SSLR for HCC presence was 0.67, 1.02,1.44, 3.98 respectively.ConclusionsLiver stiffness measured by transient elastography is useful in predicting the risk of HCC incidence in AFP-negative chronic heptatitis B patients. Clinicians needed to carry out close follow-up and appropriate intervention for these patients.
ABSTRACT
Objective To explore contrast-enchancement ultrasound (CEUS) parameters of hepatocellular carcinoma (HCC) with different cytokeratin-19 (CK19) expression in the background of cirrhosis.Methods CEUS data of pathologically proven HCC in patients with cirrhosis in Southwest Hospital from June 2005 to October 2013 were collected in this retrospective study. Two groups were classified on the basis of different CK19 expression in HCC patients: CK19 positive group (seventy-nine patients) and CK19 negative group (eighty-ifve patients). DFY-II Ultrasound Imaging Analysis Software was utilized to measure and calculate CEUS paramrters, including the enhancement heterogeneity of the tumor and peak intensity in arterial phase, the enhancement intensity of tumor and the enhancement ratio of tumor/adjacent liver parenchyma in portal phase. The difference between the two groups was compared by statistics test. Results TThe arterial phase enhancement heterogeneity of tumor in CK19 positive group was higher than that of the negative group (2.64±0.64 vs 2.29±0.31). The arterial phase peak intensity of tumor in CK19 positive group was lower than that of the negative group [(102.83±29.78)dB vs (120.65±25.49)dB]. The portal phase enhancement intensity of tumor in CK19 positive group was lower than that of the negative group [(66.83±20.13) dB vs (79.99±27.15) dB ].The enhancement ratio of tumor/adjacent liver parenchyma in portal phase was lower in CK19 positive group than that in the negative group (0.74±0.03 vs 0.92±0.22). All above comparisons had significant differences between two group. Conclusions The CEUS enhancement parameters had signiifcant difference between the CK19 positive HCC and negative HCC in patient with background cirrhosis.
ABSTRACT
Objective To investigate the information access, its influencing factors and related problems in under-graduates of medical colleges and universities.Methods Information access in undergraduates of medical colleges and universities was investigated with questionnaires.Results It was the tendency to search information on Internet using mobile phone, the interest in information access on Internet was affected by the coverage of WiFi, audio and visual frequencies were the important resources, problems existed in the matching of web page and intelligent mobile phone.Conclusion Information access in undergraduates of medical colleges and universities is affected by the software and hardware of mobile phone and network communication cost, and the healthy use of mobile phone is influenced by social environment in undergraduates of medical colleges and universities.Mobile phones greatly influence the reading forms in undergraduates of medical colleges and universities and the spreading ways of medical information.
ABSTRACT
BACKGROUND:CT-guided percutaneous intervention and rehabilitation techniques are both classic programs for diagnosis and treatment of lumbar disc herniation. Is the combination of CT-guided percutaneous intervention and rehabilitation techniques preferential y used for treatment of lumbar disc herniation? OBJECTIVE:To evaluate the curative effect of CT-guided interventional injection combined with rehabilitation integration treatment for lumbar disc herniation and to analyze prognostic factors. METHODS:Eighty-eight patients with lumbar disc herniation were subjected to CT-guided interventional injection combined with rehabilitation integration treatment from May 2010 to May 2013. Injection medicine consisted of betamethasone, tanshinone Ⅱ A sulfonate, neurotropin, normal saline and iohexol. Rehabilitation integration treatment included traction, manipulation, acupuncture, transcutaneous electrical nerve stimulation and thermal magnon. Macnab criteria and Chinese version of Oswestry low back pain disability questionnaire were used to assess the curative effects in comparison with the 112 patients receiving only CT-guided interventional injection that were reported previously. The prognostic factors, such as age, disease course time and herniation type of target segment were testified by correlation analysis. RESULTS AND CONCLUSION:Total y 77 patients were completely fol owed up for 1 year. There were excellent outcomes in 64 cases, while favorable outcomes in 7 cases, fair outcomes in 5 case, poor outcome in 1 case, with a better outcome rate of 92%.There was a significantly decreased trend in Oswestry disability Index scores at 1, 6, 12 months during the fol ow-ups (P0.05). The young group (≤ 45 years) had better outcomes than the older group (>45 years;P0.05). These findings indicate that CT-guided interventional injection combined with rehabilitation integration treatment could relieve lower back pain and radical leg pain effectively and decrease life disability level.
ABSTRACT
Periampullary carcinoma is a rare malignant tumor of digestive system,and its accurate diagnosis is still difficult.From January 2007 to July 2012,12 patients with periampullary carcinoma had been admitted to the Southwest Hospital of Third Military Medical University,and the imaging data were retrospectively analyzed.The results of ultrasonography revealed that all tumors were hypoechoic.The tumor displayed hyperenhancement in 3 patients,isoenhancement in 1 patient,hypoenhancement in 8 patients during the arterial phase on contrastenhanced ultrasonography (CEUS),while the tumor displayed hypoenhancement in all patients during the venous phase.Magnetic resonance imaging (MRI) plain scanning showed duodenal papilla enlargement in 1 patient,ampullary tissue mass signal in 2 patients,tissue mass signal at distal common bile duct in 2 patients,the rest 7 patients did not show tissue mass signal.Lower biliary obstruction was the common manifestation of the 12 patients on magnetic resonance cholangiopancreatography (MRCP),intrahepatic and extrahepatic bile vine-like expansion in 4 patients,double duct sign in 2 patients,the bottom of common bile duct with filling defect in 2 patients and it revealed beak-like narrow in 1 patient.CEUS,MRI and MRCP could both play an important role as conventional methods in diagnosing periampullary carcinoma.