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Objective:To investigate the intra- and inter-observer agreements of different experiencers using the Ovaria-adnexal Reporting and Data System (O-RADS) in the evaluation of adnexal masses.Methods:Totally 48 patients with adnexal masses (48 masses, mean size 9.5±4.7 cm, range 2.3-18.6 cm) found by ultrasound examination in the Third Affiliated Hospital of Sun Yat-sen University, from May 2019 to March 2020 were retrospectively analyzed. All the masses were confirmed by pathology or surgery. Four observers were divided into 2 senior doctors (Doctor 1 and Doctor 2) and 2 junior doctors (Doctor 3 and Doctor 4). Each observer independently evaluated adnexal masses twice using ultrasound O-RADS before and after systematic training, with an interval of 60 days. The intra-observer and inter-observer agreements were analyzed before and after training.Results:The inter-observer agreement between senior doctors were both excellent before and after systematic training (weight Kappa: 0.833 vs 0.802, percentage of agreement: 83.3% vs 81.3%). Whereas there was difference in the inter-observer agreement between non-experienced observers before and after training (weight Kappa: 0.399 vs 0.824, percentage of agreement: 50.0% vs 77.1%). After training, inter-observer agreement between junior doctors was significantly improved and comparable to senior (weight Kappa: 0.824 vs 0.802, percentage of agreement: 77.1% vs 81.3%). Before and after systematic training, the intra-observer agreements of the same doctor, the senior physicians were better than the junior (weight Kappa: 0.882 and 0.843 vs 0.440 and 0.605; percentage of agreement: 87.5% and 83.3% vs 58.3% and 54.2%).Conclusions:O-RADS risk classification system is a highly reproducible method in the subjective assessment of an adnexal mass among observers with varying levels of expertise. However, systematic training before clinical application is necessary and effective for non-experienced observers.
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Objective:To investigate the value of translabial ultrasound (TLUS) in female periurethral benign solid lesions (PBSL).Methods:Twenty-one female patients (21 lesions) with PBSL identified pathologically within the process of cystoscope or surgery from June 2017 to December 2020 were enrolled. All of them underwent urethral examination (UE) and TLUS. The detection rates of the lesions of UE and TLUS were compared, and the ultrasonic diagnostic accuracy and ultrasonic manifestations were analyzed.Results:Sixteen of the 21 patients showed lower urinary tract symptoms (76.19%). Among the 21 lesions, the detection rates of UE and TLUS were 52.38% (11/21) and 85.71% (18/21), respectively, the difference was statistically significant ( P=0.019). The length of 18 lesions detected by TLUS was (1.79±1.04)cm, and 13 lesions (72.22%) were shorter than 3 cm. Among 18 cases, urethral caruncle (13 cases) was the most common benign periurethral mass, the main ultrasonic manifestations of urethral caruncle showed hyperecho lesions in the middle and distal urethra, and the blood flow was mostly in a branch-like distribution. At the same time, there were 5 cases of urethral myoma and other solid lesions, the main ultrasonic manifestations of urethral myoma showed clear boundary, low echo and peripheral short strip blood flow. Using pathological results as the gold standard, the accuracy of ultrasonic diagnosis was 88.89% (16/18). Conclusions:TLUS is able to improve the detection rate of periurethral benign solid lesions, and the diagnostic concordant rate is acceptable.TLUS can provide more diagnostic and therapeutic information.
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Objective To summarize the imaging features of hepatic tumors contained lipid by contrast enhanced ultrasound (CEUS), and compare with MRI ifndings. Methods From July 2010 to December 2012, 17 patients of hepatocellular carcinoma containing lipid component in the 302nd Hospital of the People′s Liberation Army underwent dual-echo sequence MRI imaging. Fifteen patients were conifrmed by enhanced MRI and contrast-enhanced CT, while the other 2 patients were confirmed by pathology. The features of ultrasonography, CEUS and MRI were analyzed. Kappa analysis test was analyzed for the consistency of CEUS and MRI ifndings. Results In the two-dimensional ultrasound of 17 lesions, 9 were hypoechoic heterogeneous lesions, 5 were hypoechoic lesions;13 lesions with clear boundaries, 4 lesions with unclear boundaries;peripheral blood lfow signal in 5 lesions and rich blood lfow in 1 lesion were observed by color Doppler ultrasound, 11 lesions had no signiifcant blood lfow signal;15 lesions showed fast high enhancement in CEUS arterial phase, 1 lesion with synchronization enhancement, 1 lesion with mild enhancement;10 lesions showed portal clearance, 1 lesion showed an enhanced synchronization, 1 lesion with mild enhancement;16 lesions showed clearance in delay phase, 1 enhanced lesion showed isoenhancement;6 lesions presented intra-lesion or surrounding patchy, irregular non-enhancement areas. CEUS diagnostic accuracy was 82%(14/17), the diagnostic accuracy of MRI was 88%(15/17). The Kappa consistency test was 0.628, while CEUS and MRI results were in good agreement. Conclusions Performance of hepatocellular lipid-containing ultrasound contrast arterial phase shows non-enhancement areas. Contrast enhanced ultrasound features of lipid-containing hepatocellular carcinoma are valuable for the clinical diagnois.
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Objective To fabricate an ultrasound/fluorescence bi-modal contrast agent by encapsulating fluorescent quantum dots into polymeric ultrasound contrast agent microbubbles.Methods Polylactic acid (PLA,500 mg),(1R)-(+)-camphor (50 mg) and CdSe/ZnS quantum dots (0.5 ml,2.3 μmol/L)were dissolved or dispersed in dichloromethane (10 ml) to form in an organic phase.Ammonium carbonate solution and poly (vinyl alcohol) solution were employed as the internal and external water phase,respectively.The fluorescent microbubbles were generated using double emulsion solvent evaporation and lyophilization methods.The morphology and illumination were characterized by scanning electron microscopy (SEM) and fluorescence spectrophotometry.Synchronized contrast-enhanced ultrasound and fluorescence imaging was acquired by injecting fluorescent microbubbles into the silicone tube coupled to a self-made ultrasound/fluorescence imaging device.Ultrasound/fluorescence bi-modal in vivo imaging was acquired on the kidney of New Zealand rabbits and suckling mice.Results The fluorescent microbubbles were hollow spheres with an averaged diameter of (1.62 ± 1.47) μm.More than 99％ of these microbubbles were less than 8 μm in diameter,which meeted the size criteria for ultrasound contrast agents.The fluorescence emission peak of the microbubbles appeared at 632 nm,indicating that good luminescence properties of quantum dots were maintained.In vitro ultrasound/fluorescence imaging showed no echoic signal when the silicone tube was filled with saline,but there was a strong echo when filled with fluorescent microbubbles.The liquid column with fluorescent microbubbles emitted red luminescence under ultraviolet irradiation.The kidney of the rabbit was remarkably enhanced after the administration of fluorescent microbubbles.Bright fluorescence could be observed at the injection site of the suckling mice via subcutaneous injection.Conclusions A bi-modal but single contrast agent based on polymeric microbubbles has been successfully fabricated for the use of ultrasound and fluorescence imaging.It retains the good characteristics of both echogenicity and fluorescence,which complement each other in case of limitations imposed by uni-modal,single agents.
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Objective To manufacture magnetic microbubbles with dual-response to ultrasound and magnetic fields.Methods Microbubbles of ultrasound contrast agent (ST68) based on a surfactant were prepared by the acoustic cavitation method.Fe3O4 magnetic nanoparticles with negative charge were synthesized using the polyol procedure.Magnetic microbubbles were generated by depositing polyethylenimine and Fe3O4 magnetic nanoparticles alternately onto the microbubbles using the layer-by-layer self-assembly.In vitro ultrasonography was performed on a silicone tube with/without magnetic microbubbles (3 × 108/ml) by a self-made device to observe the movement of magnetic microbubbles under the effects of magnetic field.In vivo imaging was performed on the kidney of New Zealand rabbits before and after the injection of magnetic microbubbles.Results The Fe3O4 nanoparticles carried a stable negative charge of (-24.6 ± 6.7) mV and more than 98％ of the particles were less than 8 μm in diameter,meeting the size requirement of an ultrasound contrast agent for intravenous administration.There was no echoic signal in the silicone tube before injection of magnetic microbubbles,but there were strong echoic signals after injection.After applying a magnetic field,the magnetic microbubbles moved along the direction of the magnetic flux.In vivo ultrasound imaging could not visualize the kidney before injection of magnetic microbubbles,but could remarkably visualize the kidney after injection.Conclusions The magnetic microbubbles exhibit favorable magnetic targeting and ultrasound contrast enhancement characteristics.Such properties may serve as the foundation to study their potential for simultaneous diagnosis and treatment in the future.
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Objective To investigate the feasibility of non-invasive quantitative evaluation of portal pressure (Pp) by contrast enhanced ultrasonography (CEUS).Methods 18 portal hypertension patients (PTH group) were performed with CEUS within one week before splenectomy and pericardial devascularization,and 20 healthy volunteers as controls were recruited in this study (control group).Hepatic-right kidney sectionwas chosen to calculate the area under curve of portal vein/hepatic artery (Qp/Qa) and the perfusion intensity of portal vein/hepatic artery (Ip/Ia) through time intensity curves (TIC) of liver parenchyma generated from CEUS images.Pp was measured by intra-operative mesenteric vein catheter,and the correlation betweenPp and Qp/Qa,Ip/Ia were analyzed by Pearson correlation test.Results The levels of Qp/Qa and Ip/Ia in the PTH group were 2.28 ± 0.66 and 0.35 ± 0.14 respectively,which were both significantly declined than that in the controlgroup (5.72 ± 3.69 and 1.97 ± 0.17).In the PTH group,the correlation coefficient were-0.747 and-0.617,and the linear regression equations were Y =-83 X + 5.013 andY =-15X + 0.837,which indicated that Qp/Qa and Ip/Ia had significant correlation with Pp.Conclusions CEUS parameters,including Qp/Qa and Ip/Ia,are significantly correlated to Pp in portal hypertension patients,which indicate that CEUS could be a new non-invasive clinical method for evaluating Pp.
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Objective To discuss the feasibility of non-invasive quantitative evaluation of hepatic fibrosis by contrast-enhanced ultrasonography (CEUS) parameters. Methods CEUS of liver and liver biopsy were performed in 86 patients. CEUS parameters including area under curve of portal vein/hepatic artery(Qp/Qa) ,perfusion intensity of portal vein/hepatic artery(Ip/Ia), decreasing rate of liver parenchyma perfusion (β) and perfusion time of portal vein (Tp) were calculated based on CEUS images. Differences of the four parameters among stages of hepatic fibrosis were analyzed by ANOVA and Spearman rank correlation test was applied to analyze correlation between parameters and hepatic fibrosis stages. Areas under receiver operating characteristic (ROC) curves were calculated to evaluate the diagnostic accuracy of parameters. Results Tp and β had increasing tend while Ip/Ia and Qp/Qa had declining tend from S0 to S4.They were significantly correlated with fibrosis stage( P ＜0.05＝. The areas under ROC curves of Ip/Ia were 0.931 (≥S1) ,0.884(≥S2 ) ,0.820(≥S3 ) and 0.846(S4 ) respectively. The areas under ROC curves of Qp/Qa were 0.914(≥S1),0.813(≥S2),0.845(≥S3) and0.869 (S4) respectively. Conclusions CEUS parameters of liver parenchyma Ip/la, Qp/Qa, Tp and β are related to fibrosis stages. Ip/Ia and Qp/Qa provide a reliable,non-invasive method for evaluating fibrosis stages.